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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form ADoroved. OMB No. 2050-0039 • (X 0 g ... z ill (.9 _, UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number -Pc e_c03 i 7.63/ 2. Ple..1..of 3. Emergency Response Phone Ze7 Z.3s-orii •••? 4. Manifest Tracking Number 0 0 3 5 3 7 4 5 9 G B F Generator's Name and MAifin eismc Generator's Site Address (if differentAhan mailing address) PIA " 1 i 14.1C , ,. 5-73<e, 64.1 liu)y / Z. / 7-4 k-I tYr Oil ye Woo 0.1.50 0C7t , Cir coo/ e/t 1 Generator's Phone.210 7 135-0-079 7 i Trak° er 1 Company Name U S. EPA ID Number ttikit 610 ilAtArtk/ ,W///et- 1 r 1 04 1040 i7/3 Transporter 2 Company Name U.S. EPA ID Number Mc6 N c(\mt),(\tck.‘ &)\-k:,cyls , vnc . 1 A-t5U:tiliD2c-29_2 Designated Facility Name and Site Address \r\i-f\ McLAtt-/1/4\ kijaSte/ aALX \0(\ \ \ --I/5 IrQPN UtIc . ‘ Oa k2n Facility's Phone: ..,\\1 /41--ac- :::;A.A....A-kA , 4-1- qt::,?3-i'i U.S. EPA ID Number Af \ C-. K2tztbae52ibi-118 I ga 9b. U.S DOT Description (including Proper Shipping Name, Hazard Class. ID Number, 10 Containers 11 Total 12. Unit HM and Packing Group (if any)) No. Type 13 Waste Codes 1. /060 V_CIA kikiA1_006 lAkAs-rff DuantitypVol 11 _ P 123 1' LI (lu 1.0 (Ay fru fk--i-c-11-- Z Om ze60- '-7 1 2 3 4 1 i 14. Special Handling Instructgrip ‘tVs- 16 apil At LF ni Information \6\\\ \-0. Nake,X- 15 GENERATOR S/OFFEROR S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descnbed above by the proper shipping name, aid 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 generator) is true Generator's/Off roes Pringyped Na - Signature Month Da nuo7 /r ID Year • — 16 bona' Shipments import to us LI Export from U.S Port of entry/exit: Transporter signature (for exports only). Date leaving U.S. TRANSPORTER 17 Transporter Acknowledgment of Receipt of Matenals Tran .,i • 1 7, y WA.. j Si gnature Month (W/AJCZ I i py tO D y I Year 129-7 ,...rter 2 Printed/Typed Name ignature , Month Da i Mr AleA\IV A.LtfitiLL4k6At'AD 1 ID II') Year I 4-- DESIGNATED FACILITY --* I 18 Discrepancy Discrepancy Indication Space LI Quantity Type Residue Partial Rejection Full Rejection Manifest Reference Number Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone. I Signature of Alternate Facility (or Generator) Month Day Year I I Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 14) 2 3 4 e manifest ex Designated Fac lity Owner or Operator Certification of receipt of hazardous materials covered by th ce t as noted in Item 18a Pri yped Name _ \fILLA-bPi-t2gC ,, . i re a_Uiditr-eR1 Month Day Year I li I I 127 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. SIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)