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-Please print or type.ftfrn designe, for use on elite 12-pit.h)typewriter.) Form Approved.DMB No 2050-0039 <br /> * UNIFORM HAZARDOUS 1' enerator ID Number k 2.Page 1 of 3.J pCrgency Response Phone 4.Manifest Tracking Number <br /> wasre MANIFEST IL , "I,rv�. AA G B F <br /> r" <br /> .Ge�eral gxl aiigA Ift <br /> GeneraWs&teAddress(if different than mailing address) <br /> 6.Transporter 1 Company Name US EPA ID Number <br /> t-1t1nT0LF*1-:0ar19nNo f11a1 laaMc*&, Inc. Pinson *a0[9-W9- 274 CA.Ri.'W17101' <br /> 7 Transporter 2 Company Name U-S.EPA ID Number <br /> U.S.EPA&Number <br /> 11655 1n nue ROCK R"d �nciarva�+are <br /> nanoo cordova.t:r. 95741 <br /> Facilityrs Phone:X16-.ib" <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number,' 0 Conta nays 11.Total 12.Unit 13-Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Ald. <br /> 1. kj0%j Rr-'RA HAZAIRDOU ;Vjk ';DLED (rf * 21 Oki 77- <br /> 0 <br /> fY I 1. a i OoC� 46ft -LEL. <br /> wa has the nr,,proDrja- t,�?. <br /> 3. ;permits for, and will accept ---___ <br /> the waste this generatori <br /> 4 <br /> A4,Special Handling tnslnuctiats and Additional Information <br /> fiANDLEn TQ DE TRYAMM FANO' R-P P-e' - - - - <br /> 1Gr'4 ERG#171 <br /> 15. GENERATOR`SIOFFEROR'S CERTIFICATION: I hereby declare that Nie conwents of this consignment are ftrly and accurately described above by the proper shipping name,aid are classified,packaged. <br /> marked and Vabelecliplacarded,and are in all respects in proper condition for transport according to applicable international and national governments]regulations.If export shipment and I am the Primary <br /> Exporter,T certify that the conlerts of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I terrify that the waste minimizaWn statement identified in 40 CFR 262.27(9)(if I am a large quantity generator)or(b)(it I am a snWquanlity gRefatorj is We. <br /> Generator sfO ferods Pnnt Name -4 f lure Month Day Year <br /> I <br /> J 16.Interhatianal Shipments <br /> �? <br /> LJ Import to U& Export from U.S. Port ofenfti f�ex <br /> eavkit <br /> TranspoRer signature(for exports only): Date lrg ZLS.. <br /> IT.Transpgler Acknowledgment of Receipt of Materials <br /> 0 r 1 PrintedfTyped Name gn to Month Day Year <br /> k. _ '__ 0 n a <br /> a Transporter 2 PrintedlTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 199.Discrepancy``Indication Space ❑ entity ❑Type f ❑Residue ❑Partial Re)ection LJ Ful,Rejec ion <br /> ee r'"._ti<'C.�Cctt�Ml�j .�y�k 3C 1x:111 .�.-•- `.4 ,' :"'j-1 <br /> 1 (. rt C Mangiest Reference-Nur& <br /> 18b.Attemafe Facility(or Generator) U.S.EPA 10 Number <br /> Q <br /> U <br /> Facility's Phone; <br /> W 1 ac.Signature of Alternate Facility(or Generator) Month Day Year <br /> 4 <br /> Z <br /> 19.Hazar oi.4 waste Report Management Method Codes(i.e.,codes for hazardous waste treatmenl,disposal,and recycling systems) <br /> 2. 3. 4 <br /> 20,Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by Tie mandegt except as noted in ltem.l8a <br /> Prinledi7yped Name Signature Momh Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous edifions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />