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Form Approved.OMB No.2050-0039 Please print or type, 9 a.Ma rackl N/y��n I UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone u y - - �i .1385 F 1 E 1 WASTE MANIFEST VS�(3 2 wa-78&7225 G 'f L 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) Sala Motor Fro41 - S IK 11466 JDhrS Crr:k Pkwy Suite 40D 4620 S H4 � .fotn%Cmek GA 3W97 S oaktan, i5 Generator's Phone: l7(,6-A2;�j U.S.EPA ID Number 6.Transporter 1 Company Name GA-4YW'10W ADVAIN ' D CHEMICAL TRANSPORT LLC U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U8 EC=klaho W. Silo 8 M73114�i Rd Cat view, ID 833624 Facility's Phone: 208- 4_2276 9b.U.S.DOT Description(including Proper Shi in Name,Hazard Class,ID Number, EN .Containers 11.Total 12.Unit 13.Waste Codes 9a. P (� 9Shipping Quantity Wt.Nol. HM and Packing Group(if any)) o. Type tXlff2 1. U 1791,Waste Hyptwfdorite solutions,8,P M t r.1t- Q P _ o t-- 2. 11 N3264,Waste Corrosive lquid,addle.inotgattir: Lj4 0 P 4]ftCi2 LU 0 k rto.&(kvdrochlodc add,sdtffkc ad011,8,PGA [SpU1 . 3. UN 1479,Waste OxidlAig solid.mo.s,(SrODIUM PERS�ULFAIT , P 50DI JM 5W1k!E),'5.1,PGM ` X 4. t3MM,Corrosive solld,basic,kxwrrtc,rw.a(SODIUM i DF Ito f" AYDROXIDE,POTASSIUM HYDROXIDE),8,PCB 14.Special Handling Instructions and Additional Information PfoJect Ntnrlbur 5WM DoctlrYldrd M: D730945 1)E"154; 21M-0 30#11 3)ERQ#14O; 46678-0 15rAti 2)E"154, 486450 15#11 4)E"I5 t: 4882."5#3 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. Generators/Offerors Printed/Typed Name Signature t; -`" Month Day Year Q { •` . l ' `/`yam J 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 UJI� Transporter 1 PnntedlTyped Name Signatur , 1;: Month Day Year Cn Transporter 2 Printed/Typed Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue ❑ El Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U uu-- Facility's Phone: W18c.Signature of Alternate Facility(or Generator) Month Day Year Q z N19,Hazardous Waste Report Management Method Codes(Le,,codes for hazardous waste treatment,disposal,and recycling systems) G UJ 1. 2. 3. 4. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY \ /ti \ro� �(` n�i �"ltT�'�'_�.y'-' •`�-:•:Zs-... ..r`:r--Y-i.-,e^�---s--y-e-:.