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- T 1 ,'1 <br /> Please print or type.(Fm designed for use on elite(12 pi typewriter.) Form Approved,OMB No.205MO39 <br /> UNIFi HAZADOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trecking Number <br /> WASTE MANIFST 00007 88 DAT <br /> 6.GeneratoYs Nameid Mailing Address Generator's Ste Address(if different than mailing address) <br /> s <br /> Generators phone: <br /> 6.Transporter 1 Caroni <br /> U.S.EPA ID Number <br /> 7.Trai 2 Cmny Name <br /> U.S.EPA 10 Number <br /> 8.Designated Facillyame and Site Address U.S.EPA ID Number <br /> Facility's Phone <br /> So. ga.U.S.DOnescription(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM aid Packing loop litany)) No. Type Quantity WtNoI. 13.Waste Codes <br /> � 1' C> r.C,',' r a•t a ri�§i4 �'�ti.�. t�!6 e.b ..r� r..� �& <br /> 41 Wilt <br /> Z 2. <br /> 74 <br /> 3. <br /> 7'u rix i.:4}'iF nt,. <br /> IMAP <br /> J MAP �!tk4 f •.chi.60 <br /> 4. .. -. <br /> 14.Special Handling INmchms and Additional Information -- - <br /> i <br /> § ,7 '.. F�;,'' -. t:yEatT }iU t• i¢ kiitf let a�b.ir P. !t> ii!6i t;i6 <br /> 15. GEN ERATOR'SfGFEROR'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 labelillplacarded,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 tat the contents of this consignment confmm to the terms of the allached EPAAcknoWedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneratarsrOfferor's Pmtedrryped Name S�nature- Month Day Year <br /> J 16.International Shipmetis' <br /> I- ❑Import to U.S. 11 Expert from . . Port of entry�iut 1 <br /> Transporter signature(hr exports only): Date leaving.: <br /> CC 17.Transporter Acknowledgment of Receipt of Materials <br /> W Transporter 1 Printedl7ried Name Signature Month rrDyyay/ Year <br /> a 1f <br /> O } / <br /> GTmnsporter2 Printed?yked Name Signature Month "Day • Y€ar <br /> K <br /> 18.Discrepancy <br /> 18a.Discrepancy Indicaton Spars ❑ Quantity ❑Type yp El Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate Facility(orGenerator) Manifest Reference Number. <br /> U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> w 18c.Signature ofAtemate Facility(or Generator)F Month Day Year <br /> Q <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/Fyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />