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Form Approved. OMB No. 2050-0039 GENERATOR -- .••• - UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number Greteco-, (11 9 9L-1- 2. Page 1 of I 3. Emergency Response Phone eco- s-s-&,-6),o90 4. Manifest Tracking Number 0 2 2 2 2 8 5 3 1 JJ K Generators Name and Mailing Address Generators Site Address (if different than mailing address) JR--- co 1 .-.- _3 a 14,,,,,-- Cm 'f- 0 $-...-4.--e-_ ADrpr-t ...i,-; 12.0-r t_i fa.a. P---. -72-1 1-4S- Generator's Phone: 'EC2-zi.ac-i-i CA,AA p , A 9,9 Transporter 1 Company Name U.S. EPA ID Number kg,JU), L-I M (f)t p-iiJe-- 1 CA4ID9 9v --7 .---7 06%. B Trriporter 2 ComgrIly Naml ov U.S. EPA ID Number Ui 40 Y\ , LiAc I 0./A-Olet-e0 CLOI 9 Designated Facility Na e apd Site Address U.S. EPA ID Number C--s‘-f-- " F.-1 1- &ANL-my- 0 .---1 I (03. o ‘,-) r-1-4 _Tr12--c..--r-' FUFstc-P-Friog? CA 9°1' I (-4--z„.12_ -S-L-1-k-i- S--- I(t)?- 0) LI (-99 6 I 9 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes imi and Packing Group (if any)) No. Type Quantity Wt/Vol. I -et-z--A-O.-\ Ltif.r-=;r7-j." _ot....-ir, `-i-2-- 2-00 --V- 14. Special Hapraing Instructions and Additional Information ---1.0 k,,t__ 1.1/4 j Q or-t 1 C._-t, a- - LA-9 -a7v4..._- k..e...0i=,-------11-- c. %--014----1 .. t....iD.L.-si,/a, • - l..: . - 003- - t> ri t c 1 . GENEFtATOR'S/OFFEROR'ERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, arrl are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national govemmental 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. Generators/Offerors Printed/Typed Name 1.1,-) ,Qe-,--14t.F- Or- -__Ir 14LAN/T-- Signature Month Day Year . A. _ I /10 I 41- I '2-2- ._ _1 r- 16. International Shipments LII Export from U.S. Port of entry/exit: Import to U.S. Transporter signature (for exports only): Date leaving U.S.: EY tit re 0 o,.. 17. Transporter Acknowledgment of Receipt of Materials I- Signature7.--, Iran or 1 Printed&ed Name Month Day Year ............--, erm......... I I / 0 I X 12--"'- cn Ira rter z P sled/Typederne Signature (-4--_ Month Day Year DESIGNATED FACILITY I. 18. Discrepancy Discrepancy Indication Space LI Quantity LI Type III Residue LI 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 recycling systems) 1 Et ItArl 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a Printed/Typed Name _. Signature Month Day Year &VCt--- ti9 1 le I 10 I 18 122 •••-•••••••• • •••-•-.•, , • A," yrs, res rn A I.. .. •• A mirne-r eVO1C111 EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete.