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bbL bK 6H I N# 4440-,t-� 1111111111111111111111111111111111111 2-:9 Igo 0 0 8 5 3 9 1 7 6 S K S Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Pae 1 of 3.Emer ency Response Phone 4.Manifest Tracking Number WASTE MANIFEST �( � i-t�k�-4Eid-1 16k) 1008539176 SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) U1 Reilly # 411`: I301' b Harlan Rte LH I f-fi*'UP LH Generator's Phone: 6.Tfa sport r Compan Name U.S.EPA ID Number br -p'EIN� Y t cPi i NL 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address LLLHI'4 hHHJJUHb I.jRHbaY PIUUN I H 1 N U.S.EPA ID Number 6 llil-Lb t%f, i M1 Ltd NUR I H KHULL6 t},1 1 41, UI-I- 1-80 KNULLb s +J I 840bJ, Facility's Phone: 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM an cking Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1.AAE, NUI'4-RL RH H#4LHHi) UUb WH6It' bULll), o (ML I HL iUUb i HNO MHL:HiN1NU WHb I L lie", / -75a LU I Z 2. LU i 3. ------------------ -- I-- 4. i C I } 14.Special Handling Instructions and Addinal Information 161) bm UR 1 b I I b LrbLi tori Lilt HbLINILY#600-41nd-1IbO-UrzitjKi IFI-i.ontract ret aineol Dy generator con ters agency autrtorrt on initial transporter to add or substitute additional transporters on eneratorf s behalta 15. GENERATOR'S/OFFEROR'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 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. GGen�eraattoor'r sslOfferors Printedrryped Name Signature Month Day Year LAX 6 Ak 16.International rt Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Matedals f- Tr orter 1 Printed/T ed Name O PAICE YP Sig to M� pay 11 2a�i CL U) Transporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ uantity ❑Type ❑Residue ❑Partial Rejection ❑full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number U L<L Facility's Phone: M 18c.Signature of Alternate Facility(or Generator) Month Day Year F- Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedriyped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM I)�{FGk3"�ti:f b4�i:�1