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Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number a4600 317 220cr 2. Page 1 of / 3. Emergency Response Phone 80,9-aq" 4. Manifest Tracking Number 0 2 2 4 526 20 JJK Generators Name and Mailing Address Generators Site Address (if different than mailing address) L,f ,1-etC.1, TTS/ LLL. 1000 Rath Rd LLSOOSciirsburygoad Site IMO Frencli Cum'', Gig cTS-231 Sackson v rile, FL 2214.„.,„_, Generators Phone:at' 0 LI - 'I 1,2. Transporter 1 Company Name U.S. EPA ID Number I°61-ty10-t Erivirvnmentql Scc Vic rs ICAL10.53 .8 667? li Tr rter 2 Company (ovi ) Naroe CMA / 4-bin , 1,1/AC U.S. EPA ID Number I /4 ,52q()4 0 ig Designated Facility 6(10S.6y i C,VC-rt.494 16-20 tt ) '171-th Lon?r 130-ath, Facility's Phone: .S62 e and Site Address U.S. EPA ID Number Stee-Ce„ CiEl cf °Li (-5 I CAD lo28zioyo/g - 4321.- ,S-14 4 .0 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes FiNt and Packing Group (if any)) No. Type Quantity Wt.Nol. cc 1,w3r7s, 4,e.c ytt So PC4 to ri tainD.- -C I q r)7yric.d. It. /rel.( ras., A a_s • 352 (Abl,dKn-e lattbris 4)/flafitrnatb1e Zei kl iti, ph .3r Di\1 3 5-0 P Doi z Lu 0 S ecial Handling Instructions and Additional Information So), -1; I I - 2 Z -00336 eiv-ftteo /00/37 6 )__1.610ci 41Weiy) wear cf.Ewiziri handknj- lvta>t 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, aid are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations. If export shipment and I urn 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. G: • rators/Offeror's Printed/T .ed Name ature Month Day Year .. ,„„ole 441-414•1 43 Z 1 JP. '" .4 dkai 111111ft •_.... . (PL i r.-I 1". ntema ona hipments Import to U.S. Export from U.S. Port of entry/exit: I- F... Transporter signature (for exports only): . Date leaving U.S.: I:. 17. Transporter Acknowledgment of Receipt of Materials TRANS PORTE Transporter 1 Printed/Typed ame Signature Month Day Year if ID ,71 1,, 9 . ransort ' p ikck- nnted/Typed Name Signature Mont Day Year ILA- • C1-&1/1 544-- 1 10-( 121 ILL *----- DESIGNATED FACILITY -0. ' 18. Discrepancy Discrepancy Indication Space Quantity III 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 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyding systems) I. Id 12. 3.' 4. 20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Name je s s 1 ca..._ L6 p-C I Signature r)- 1 Mionth Day Year ll I 76 I)--Y _ ____ EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DIVNATED FACILITY TO EPA's e-MANIFEST SYSTEM