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t� Please print or pe. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Ma s racith! Nuun F L E WASTE MANIFEST 1d:SfX 1 ui. � 383 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) VIA Motor Freight Saga Motor Frolot - S 1K 11465 Afts C.mk P'kwy Sudo 400 4620 S K �6299 Johns t�:"k,GA 3t1097 Stockton, is Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number ADVANCED CHFMK:.AL 1RANSt OR-11.LC CAROOtI070641 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number US%101 r Nei, 6�c FSeii My N Mr�i ofSwity h(�100M Rty,Facility's Phone: ,7! ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes Him and Packing Group(if any)) No. Type Quantity Wt.Nol. I. t=N t 950,Waste W w 2. 3. 4. 14.Special Handling Instructions and Additional Information 1) 00:287562-11 SDF#-1 15. GENERATOR'SIOFFEROR'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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental 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. rator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments Z ❑Import to U.S. ElExport from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed[Typed Name O Signature Month Day Year z Transporter 2 Printed/Typed Name f ,>! Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: J U.S.EPA ID Number U Facility's Phone: w 18c.Signature ofAllernale Facility,(or Generator) z Month Day�y..r w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,c � 1. �2. p rl✓�Ip,K 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by th Prinled/Typed Name Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY