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[IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII Illllll!IIIII II IIII Please print or type. Form Approved.OMB No.2050-0038 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number /� WASTE MANIFEST a�u-a3� 001505596 Ge rotor's Name and Mailing Address A_ ,i.,t ��f1 w'r Generator's Skte Address{if different than mai{ing address) 5-I ZA MiAq V�r, Generator's Phone: n. 6.Transporter 1 Company Name U.S.EPA ID Number _ �iea^ec^crime-e:rmeriat inc;.— 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address _ U.S.EPA ID Number L`Ri1L E ^L VV Facility's Phone: ga 9b.U.S DOT Description(including Proper Shipping Name,Hazard Ciass,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity VVt.Nol. 1. O s tiw inatiQ.iiA CC-T A=DvVC J v.�.i UIfU JJ t w IL z 2. W 3. 4. 14.Special Handling Instructions and Additional Information -QB2 j"....PH E€: /71 �{L f l I USE GL01 EJ:d`SU:7::JL7;-E--z..TRUCK C,•SLLER I-VIUS 1 If.lEI7TIr i CLE.J`d 1 E.Ci":EL'NEtC4 S`: '1 Ei`TnL.': M-E&J l E l:V;'C'I111 0-00-5-'..5 .50053 15. GENERATOR'SlOFFEROR'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 labeledlplacarded,and are in all respects in proper condition for trarspori according to applicable international and national govemmertal 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 m a small quantity generator)is true. Gene r's10H s PrintedlTyped Name Signatur4 Month Day Year ,Nl�✓1 `e Z 25 � 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials E— T nsporter 1 Pr i tedlT pel Name Signature Monfty Day Year O a ZTransporter 2 PrintedlTyped Name re Month Day Year 18.Discrepancy 1 Be.Discrepancy Indication Space El Quantify E Type El Residue Partial Rejection Full Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J_ U Facility's Phone: W18c.Signature otAllemate Facility(or Generator) Month Day Year a z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. � 2. 3. 4. 20.Designated Faciigy Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as toted in Item 18a PrintedlTyped N e Signature Month Day Year f 516 ^PA Form 8700-22(Rev.12-17)-Previous editions are obsolete. DE GNATED FACILITY TO EPA's e-MANIFEST SY TEM