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Order #- 087924-l), Please print or type. Farm Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST OO , 1 14f J .L E DAT 5.Generators Name and Mailing Address tttrrraly Generator's Site Address(if different than mailing address) ;.J:iv Al-r"1 mow ► w" r-r, r ,;i fi,1A Generator's Phone: 6.Transporter 1 Company Name U.S. EPA ID Number r t"`L Fti N764i FJb04`>., (W)000626325 7.Transporter 2 Company Name U.S. EPA ID Number loynr4ol'i L-wntsi L! ;ru (•••E!tl 87ag �"2*1 8.Designated Facility Name and Site Address U.S. EPA ID Number Hwy tiff, 12 n>W t;.kiuui tAUi wily Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wtivol. (.Gift !USIVL LILIQ08, F-LAKIOA+ ii.i;_L, N.w;. 0 (SULFURIC AUD, 130PROPANIX), 8 (3). 11 z 2. LJ 3. 4. 14.Special Handling Instructions and Additional Information I_I�) I It•r (lilt it fl'L' rrl o� ;'i •.: ki 1�.' , il .i\ IESI `I Yll, 1! 02. (0701315(0 .1i8� )NIrlklTF WAIE:R TESI VIALS A t-17 C:onirj A mcrvwA by 10tomm nornnt ogm Kn/aiiw"a,lei%ry WPW*W tra fic"nr 14 rx1 wbo e,.na;.,thr,fa ry•f Y-';R nr.E:.N,7Y 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 Month Day Year J 16.International Shipments F ,❑Import to U.S. ❑Export 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 Signature Month Day Year O U) Month Da Year Z Transporter 2 Pnnted/Typed Name Signature Y H 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity Type ElT El Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S. EPA ID Number J U U- Facility's Phone: W18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 2. 3. 4- r Designated Faclity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a nte:ryped Name Signature Month Day Year EPA Farm 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY