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Or(W #: 6879244)( Please print or type. Form 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 'i_i OO '' 15 DAT 5. Generator's Name and Mailing Address Generators Site Address(if different than mailing address) }ra17JkJI) JU(Al wly lJl ;r ITN:[�l>lrtulel CMja�►g +: .. :• i . 953041618 209 81418,'118 Generators Phone: 6.Transporter 1 Company Name U.S. EPA ID Number {•"k:R187f,#S UOrH '•) 0000026325 7.Transporter 2 Company Name U.S.EPA ID Number n 8.Designated Facility Name and Site Address LLC U.S. EPA ID Number `tT6•blC-[Tt315 Facilitys Phone: ga 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 WtNol. 1. i iPJ : tYI, vV;V-- IL. t. ..jJ01 .JiVL LIOUR), At:;;iuiG, 1140;;UMIC, NJIt a. 0 (WLIVRIC AC4U, HYDROCHLORh:ACID), 8, PG it Z 2. t. 1 3. d; 1 L QQKKQ.$IVL LIQUID, I 0XI-C'mu. . (5uuumu Aro ww't Ric s;;IIiFArF), A (6.1), PC 11 4. tai;'t)Ji>, II. ii7At L101JIV, ()W;ANJC., N,C),S, (0-TO WIr3INFF, i VAC)/4C FTAn!), 6.1,AG 11 `- 14.Special Handling Instructions and Additional Information 03: (1887623)C1 -031RL0: , 911I15GH2 02. (IN/F12.1r,1 -0?/INC14-C: 1.r5G H2 04: (1887823)CT-041 IW--:14•P 15G H? l,IMif/1ti;t frAw Kwi tq #"kf J m*Av'*Gfl oftd h*monAW Ql AM or 6i"bule add r1W oil 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 wnform 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 Prmted/Typed Name Signature Month Day Year 16. International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: iX 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name ! i ' Signature �%! Month Day Year Z Transporter 2 Printed/Typed Name Signature Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S. EPA ID Number J_ V ua Facility's Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1 T 3. 4. 7 1 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