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Please print or type (Form designed for use on elite(12-0ch)typewriter' Form Approved.OMB No.2050-0035 <br /> UNIFORM HAZARDOUS � ^r raUr ID Numbst 2 Page t o! 3 Fore ntncy Resounse Phone 4 Manifc.t Tracking Number <br /> WASTE MANIFEST <br /> 015482399 JJ K <br /> 5.GeneraWss Name and Mailing Address _ Generator's Site Address(f different than mailing address) <br /> 1060 <br /> ;en e4e^e- <br /> Generator'sPhone: 7/-39�-'l <br /> 6.Transporter t Company Name U.S.EPA ID Number <br /> �0-53Ci 6 79;� <br /> a s:rter t Compary'Jan e <br /> —S "eP�,ID Number <br /> ` rO A15 04" �O <br /> 8.Desgnated Facility ame and Site Address U.S.EPA ID Number <br /> J?t v-ew <br /> C/,2$' 6'Sis ,CAI �.ty/r�.ar,�nC, �.�i �1i3n/ /►� ` <br /> Fa [,} <br /> l!l s Phone:3.2 3-7 76 ?� t?7I CSG 6 /-S <br /> qa 9b.U.S.DOT Description(inducting Proper Shipping Name,Hazard C:as;ID Nurrcc• 1+ Total uo:; <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) W. Tvpe ouarery Wt V6 <br /> IJ C J27r/14 Gt.k617�r , ;.s,!c/e W7 (5cb:r !�tYA <br /> 0 cv,#, A,4,8, <br /> LLIZ 2�ln/v -/��Raj f/-r,�.�lo<ss �s/.�� �/`!,( <br /> t, le-7e <br /> 3 <br /> I <br /> I <br /> r <br /> 14.5{waalHandling msUuct n6anc%ddita,tailnfcrma an Ark <br /> r%wl CtRcl—l✓T�/ cyS�lo(1^• �j€ ((JIVE /jn- X <br /> i7 <br /> f ixsS'-) ��XS n ,28f3 �6 7�' /--.e ,74 OAT <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby deciare that the contents of this consignment are fully and acccrately described above by the proper shipping name,and are classified,Packaged, <br /> marked and labeledrplacarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify trial the contents of this consgnment conform to the temts of the attached EPAAckrwwl*ment of Consent. <br /> I certify that the waste minimization statement identiked in 40 CFR 262.27(x)(if I am a large quantity ge, b,{if i am a small gWtity gene%rator)is tore. <br /> Generates+Orferors Prirfied/Typed Mame ,JPr. Ate/ . Slg a Month Day Year <br /> /� p /8 <br /> _j 16.Iniemaiwna,Snipmenls j ,c <br /> U t Export rrw: y- <br /> Transpcner sgnature('or exports only, Ja.e leanny U S <br /> 17 Tra perterAcinar+iecgment of Retelpt of tsaterais <br /> w Day Year <br /> If Transporter 1 PnntedTyped Mame Sg:atlrm + <br /> 0. t ( V ILA tlorri Day Year <br /> Z Transpor,ar 2 Prntedrryped Name <br /> S:gnaUre <br /> 18.D'+saeperw.y <br /> 18a Discrepancy lndirat,on Spa.;e L_. Ouanoty ;'rye Residue ❑Partlal Rejection Full Refecdicn <br /> Manifest Reference Number: <br /> 18c Adiemate Facility(or Generator) U S EPA ID Number <br /> 1 <br /> U <br /> LL Fac+ktesPhone: <br /> r--- kLU <br /> Nternate Facilmj(o•General::; t6onth Day Year <br /> Q <br /> Z <br /> 0 19 Hazardous'Baste Report Management Method Codes ji.e.codes for hazardous waste treatment dsposa!and recycling systems; <br /> T_ <br /> LU - 2. 3 <br /> D ' <br /> 2t' Des;gnMed Facility Nner or Operator Certificatton o{mcelpt or hazardous materials ce aererf by tfw manifest except as hoed;n Item 18;; <br /> .rintedJTyped Name Signature Month Day Year <br /> EPA For,8700-22(Rev.3-05) Previous editions are obsolete. <br />