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Please print or type. Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 7GeneratorID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number y� <br /> WASTE MANIFESTLUtk1U4CH.)3i} " r 00 j 4 57 14 , V 8 DAT <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> '. n'- 1 �t..:..; , :!n;lillrA-y !?.T111;�t�tNiot q!IorK� <br /> TOO <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> r . <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> hl 4iar� t ••r.:t�l tt7E1h•t1ttU.,` •) :-,IROR0IM <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 1 t Fthpr{(l Srta81 t X098266024 t <br /> 1 Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11_Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity WtNol. <br /> 1. <br /> 0 )fk{'sca:��{, 1f�('a..31n,�(;.!!?Rttl".��($ (!yU{•�". CS11'it)a{'15f, S11J�. (434rf21'4¢3SiCr(, ' i . <br /> y <br /> acid),; (3), PG tl, ERG 132 <br /> z 2. <br /> LU <br /> CCrrfr).9IVe 9aitd, acki)c. InoffWle, n.o.s. (hy'droxya"Hne <br /> L.R'(3 iC,I <br /> 3. p <br /> �•1�a.:�r�aMy1�}•Kati.+IRW3IUJQif�ltHttl}Ai?'iJ"!�,�7(�-I��•r.I„r..t�.y,,.tJ�Q_. , r i .. '� <br /> J <br /> 4. <br /> f,)r,ri.;2C,F?:a. Na'�nrrinrP, 1Nrrs.i^ 1 Sit,l<! (i�irhl:ifty ,.; nclaMl , ' : It i i '' � <br /> 14.Special Handling Instructions and Additional Information <br /> 01. (108tic)V4WL1/fiU )YJLV1l.alFir:. <br /> Gi: 00852)o/4V&2J50 04: (10H52)WWL415G <br /> !.':uM::i fnq)Nrz!trJ}lease,,) "4p.ru(Aj1^.:1'npn's-or MI kfi1:1r T•7Yeri'RiW is W-1lot W.ASI4UIJ pgdpL n.:� <br /> 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, <br /> 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 <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> Generators/Offerors Printed/Typed Name Signature Month Day Year <br /> ,J 16.International Shipments <br /> H ❑Import to U.S. ❑Export from U.S. Port ofentry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TransporterAcknowledgment of Receipt of Materials <br /> Transporter 1 Printed(ryped Name Signature Month Day Year <br /> O <br /> IL <br /> Z Transporter 2 Printed/Typed Name Signature : Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity El Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Altemate Facility(or Generator) U.S. EPA ID Number <br /> J_ <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> y19. Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />