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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 ; jUU04UU:0 100J � i '.,0- 327 DAT 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) ,.:ity Lit Trwy Wastswedor Laboratory ATTN:OnMel Duoity .,900 HcAy Dr Generators Phone: .'U9-tf I-WId 6.Transporter 1 Company Name U.S. EPA ID Number it"Em 87E64)(MA4.) n6000626321� 7.Transporter 2 Company Name U.S.EPA ID Number "6325 CAUUUU6 8.Designated Facility Name and Site Address U.S. EPA ID Number y VS' 12 nWif St).ulh of Beatty WV 1 1 t. OW Facility's Phone: 9a 9b. U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity WtNol. 1. 0 + � � NOFd~R;':P.A hIA7.A4it?OUS WASTE I.t{141tD (CCTRIC ACID, OutANNl74L) ' z 2. Uj UN2920. WASTE CORROSIVE UpUIDS, FLAMMABLE, N.O.S. 191A.POP,IC ACID, 190PROPANOL), 6 (3), 11 3. 4. 14.Special Handling Instructions and Additional Information t it i . j;;llr ii .; i L WATER TEST VIALS (0/0:i394(32-1.)MTRATE WA'rER TES-1- VIALS-(flammable) i-1*19d by Owmalf f conl6m AQAnCY AUAherih'an kd W transWat to Add(N Kituftme addWa{r 15. GENERATOR'S/OFFEROR'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 intemational 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 Prmted/Typed Name Signature Month Day Year J 16. International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(far exports only): Date leaving U.S.: W IT Transporter Acknowledgment of Receipt of Materials LU Transporter 1 Printed/Typed Name Signature Month Day Year, O a Z I Transporter 2 Pnnled/Typed Name Signature Month Day Year H 18. Discrepancy 18a.Discrepancy Indication Space ❑ Quantit y El Type El Residue ❑Partial Rejection El Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S. EPA ID Number J U LL Facility's Phone: H18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 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