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.... - - 77777 RECEIVED Please print or type. Form desi ned for use on elfte(12-pitch) ) Form Approved.OMB No.2050-0039 P. P ( p }typewriter.:: UNIFORM HAZARDOUS 1.Generator ID Number y Z Page 1 of 3.Emergency Response Phone 4 Manifest Tracking•.Number r. %fig KC L. ,,. :�'�$ h 8`'� • a k.tLr & ice' '� t7^s g 3' �.`V WASTE:MANIFEST E." r ' ' l 0 '320 S 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) :�. i•.M•'t 3�'i.'A L' ' '�` �.�'., # ?ran J.l.t sem`-. is..» .:3 }: ay ..a�xe.rste�. as .. .,�y �e$$ yry&, I 3�4aymgy ':.x..� .L P*.i'n' 7��d`^.d.�� `'�.li.S:: k-•��.'�5"v�? � y+�0• .. 6.. �+aa',Z.rA xY fa Generator's Phone: 26907 13 5:3�f }o# 9 ��,",:�a.�" 's ,._ 6,Transporter 1 Company Name U.S EPA ID Number t AR:E °4`^`ut'.r...E.EN 6 r-f Es t-„�g INK-- 7. .8',r.Q7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number CLEAN HARBORS BLffTM-WILLCU, LLC 500 LCH'TRIN' ROAD x.'�F�C" id7`fi .�x3.}:..^L+6 FacilitysPhone: � :cC15,111156106=;x'2761 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 VJt.Nnl. 1 :,.e r NON RICIPI s HiA. .k cRD01.3:.1 W.ffv""A T Wiz'.a D �+p v�Ay^� x%r RRENT,,Y 'r 2trr` WI'6"9#�S Rr^:.,� qsy. LU Z 2. LU 3. i 4.. 4 Special Handling Instructions and Additional Information y: .. F-4 Poo E D i..}.�''ycp.:�-.�'..,.f`�''�o ". ._. " .•.. 3i f (3•:i2'q @ s. t5 17 rr" t •... } an .'* '�:b-},9.�e z>w. > F SUB r. �«..�. P: w.>r.+a g 7 B r tl'-g„..Fl f F? I�f�I N L I.CI�2:ED SUB 9,�1-#' �t.�}. R-19 AS s€�f:; t^ ..SARY 0. ai A+. s r 15. GENER T6kS1OFFEROR'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,pads ne marked and labeled/placarded,and are in all respects improper 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 Ihis consignment conform to the terms of the attached EPA Acknowledgment of Consent. I.certify that thgwaste minlmizatlon statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)Is true. GeneratorVO1 ierors Printedffyped Name Signature Month gDay Year 16,International Shipments. ' ❑Import to U.S. ❑Export from U.S. Port of entrlexit: `Transporter signature(for exports only): Date leaving U.S.: w 17.TranspoderAbknowledgment of Receipt of Materiels Tr porter 11 Pon IT yped Napa` gnatyrE .'` Month Day Year Q Transporter 2:P.rintedffyped Name rgnature Month Day Year <. ;18.Discrepancy 18a.Dlscrapancy Indication Space ❑ uantity ❑Type yp ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Fatality(or Generator) U.S.EPA.ID Number a V LL Facility's Phone: w 18c.Signature ofAlternate Fadlity(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) d 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 PrintedlTyped Name ;S'gn re <9 Month Day Year r rweH �. > e ' a fr.ik r.''w.„,,,ir. a EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGRIATEb FACILITY TO GENERATOR 1.)73'74893/4073 49� i