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Pieasa print or type. Form Kamd.OMB No_2050-0039 <br /> UNIFORM FHA7ARD0U5 1 Generatrtr ID Number 2:Page 1 of 3:''Emergen Awsponse Pwne A manlfectT umber <br /> WASTE IIAkNIFEST r Y r`&t>�i="4 , <br /> S.Geoarator s Name end'Ngling Address G6idsratars Silk 4rldr 4 ttmn.maTaig edaress) <br /> JCiI <br /> Generators Ph one'". �.. <br /> s Trans"r1 Cam iYer(re Ti—EPAIDNuMr <br /> 7.Transpvster2 Na [f.5.ER4Il].Nsttr>her <br /> 8.Designated fadjq Maine and sitsAddress "U.S_EPA FD Number <br /> �� <br /> r s n kw h �rfr� k. 1 <br /> Facili3y's Phone: <br /> ga 9b.U.S.DOT Description pnduding Proper shipping Norm,Hazard Class,ID Number. 10.Contelners 11.Total 12.Unit I 13.Waste Codas <br /> i HM and Packing Group(If any)) No, Type Coidiy ",MI, <br /> z 2. <br /> ua <br /> ra <br /> P 3 r <br /> II. <br /> 4 <br /> 4 <br /> 14.Special Handling lnstructlons and Additional lnfamratren.; <br /> f�L.f\'S3}'(i �Ci. #".�..7"M.lt'3` •;...,u. G:' �' "'if ; <br /> 16. GENERATDR'SIQFFFRON'SCERTIFICATION:Itrerabydeciare that thocordeM§dthlsronsignmentarefully'andaccuralelyci ltx:dabovebyftpropwshilname,ardaredassified,packaged, <br /> marked and tabeiedlplaearded,and are in afi respects in proper condlkn.for traraportaccordhy to appiieal international and notional governmental regulations.lf export shiprrrent and I ant the Primary <br /> Exporter,i cerffiy that the contents of this oonsignmentcanform to the terms of ft atteciiad EPAAdmcrMedgmerd of Consent_ <br /> I cart fy that the waste rr nimization statement identified in 40 CFR 262.27(o)(if I am a large quanldy generator)or(b)CC am a smalt,quan2y generator)is true. <br /> Generators(offerors PnnleWyped Nkme Signature "p Month Day Yew <br /> 16.IniemationalShipment E'Importto S t�lE ad from U.S. Partofentryle>rt �'� rEfl' <br /> E Transporter signature(far eKpprts only): a d-r: _, Date leaving U.S.. - <br /> w 17.TransporterAcknaMedgment of Receipt of Maw9s <br /> I-- Transporter 1,Fhn4Vjyped Nape S g sawre r Y - Ygar <br /> 04 <br /> Z Transporter 2 Pnnted'Typad Name Month Day Year <br /> F ' <br /> 18.Discrepancy <br /> f18a.Discrepancy Indicat on Space11 Quantity ❑Type ❑Resdue ❑Partial Re)ectlon 0 Fufl fieestian <br /> j <br /> Mardtest Reference.Numbar: <br /> F IBb.Attemate Facility(or Geriermor) U.S.EPA ID Number <br /> 3 <br /> i v <br /> rQi Fadlity's Phone: <br /> a Bc.Signature AifemateFae4ity(orGerrator) on ear <br /> Q <br /> 19.Hazardous Waste Report Management Method Gads{i.e.,codes for hazardous wasts!reaNunt;dtsaosal;and.reoyulingeystsms) <br /> Ul <br /> 20.Designated Facility Owner or Operalar.Ce t firatiort of raxiptof hazardous materialsoovered by the titan fast eYwpt as reGfad in ltetn 13e <br /> PdntedETyped Name r ignawre MmM Day Yea <br /> EPA Form 8700-22(Rev.,12-17) Previous editions are obsolete; DESIGNATED FACILITY COPY <br /> IF YOU RECEIVED,THIS MANIFEK,YOU HAVE uSPONSISILHIES UNDER THE e-Rh NJFEST ACT.SEE INSTRUCTIONS'dN OEVtRSE SIDE. <br />