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Please print or type. Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS ID ManifesE 385 Number SKS WASTE MANIFEST J. 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) IN Generators Phone: 6 Transporter 1 Company,Np,me. U.S.EPA ID Number 7.Transporter 2 Company Name l EPA ID Number i>U JVt".- Mw 8.Designated Facility Name and Site Address U.S.EPA ID Number Facility's Phone: 98, 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11,Totai 12.Unit 13.Waste Codes HIM and Packing Group(if ani No. Type Quantity Wl 1 p tri: ii LulA t H,"Iw-( r x i ff, L,1 LU Z 2. LU 4, 14,Special Handling Instructions and Additional Information c", n I r!a i C�tsii i`. 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled)placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, , I I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true, Generator's/Offeror's Print e 1 d[Typed one, Signature Month Day Year 16.International Shipments 1-1 Import to U.S. from U.S. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials W Transporter 1 Prini Name Signature Month Day Year 0 CO ZTransporter 2 PrrntedlTyped Name Slgnatura f Month Day Year 18,Discrepancy 18a.Discrepancy Indication Space El Quantity Li Type Residue 'Ohirti&R.eijec;tior El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U Facility's Phone: U" 18c.Signature of Alternate Facility(or Generator) Month Day Year Z a 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 2. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY