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PIS esa print or type (Form designed for use on elite(12-pitch)typermitar) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.G_anarstor ID Nurnber _ 2Pageld &Emargercy Response Phone 4.ManiNst Trackin�pg Nqumbb�eeyr <br /> II} WASTE MANIFEST f;"4h3 t§r.7r;iY'-? �',e`'1 h' Ii 'Id"06Y4278 P a DAT <br /> 5 Geremofs Name and Mailing Address Gemeratio6tits Address Of deemed ttan meting address) <br /> Is L -:1' I f±i{: : <br /> IIS �•'!:'Z, v. 11".yy lnVfo ji j1, tel.�."r <br /> Genemen's Phare is'.f.7{,f' 9-t !{: ?,(. '. is '-q- +i;1" e5 <br /> II.Transporter 1 Company Name U.S.EPA10 Number <br /> Ip,r}.r1= t,l av 1or 11:111. (.(" tti?:Lti,to 'I I.i ;. <br /> 7.Trenepaler2Camperry Name - U.S.EPAIO Number <br /> &Designated!Facilty Name and SMAddrxa - U.S.EPA ID Number <br /> ri t•:R, vl res 41 aw !1 r aor re':yiMi to .. mer; <br /> Fadh saPhone: <br /> 9e. 9b.U.S.DOTDeea'pom Onduttng PmpwSNppirg Nn ,Hazed Class,ID Naha, 10.Can are 11.Total 12.U11ft 13.Yhsa Codas <br /> HM and Pecking Grow(dary)) No. Type Owdry WIM. <br /> a r •.;e.�) -;;.1 r y.'L ;y{Ir1 A fir;>E! <br /> Ko. 1 i F1 se f <br /> O <br /> rl. <br /> -------------- <br /> W <br /> a <br /> 1 <br /> 4. . . CF•+'' 3tliftf .Si. <br /> 14.Speddl HaodiglnsbucbonsandAddigmalbdamaton <br /> is <br /> iS GENERATOR'SrOFFEROR'SCERTIFICATION:Ihaeby oec'are that the contentsoftlusconsgnment are fully and accurately dumbed above bythe proper shipping name,and are classified,packaged, <br /> marked and labalatllplacarded,and are in all respects In proper condition for transport scoordhg to applicable intertmMndand national gowcemental regulations.if export sMpmemt and t am the Primary <br /> Exporter,I cedlfy ftt me contents of me mreignmem,mmamn to the tenns of the attached EPAAcknwedgmenl of Consent <br /> I costly that its waste minimization statement Identified In 40 CFR 282.27(e)(f I am a lege quantity generator)teriQH am a'armi quentro generator)is bus. <br /> GimeralcfslOeaofs Prime Signshme \ [ t,._ i nth Day Year <br /> r v �J < <br /> >.,y. (f,(.� ._ - +r: .�1- ,'Y d/-..P (' isUiL <br /> 18.Inbemegonat Shipments <br /> ❑Import o U.S. L1 Export U.3. -s Pagaferdylaxll: <br /> Traipmrrsignaore(loremporteonly): - Date fravig U.S.: <br /> 17.TmmporlerAcknowledgmeMof Receipt of Materials <br /> TrormporterIM itName Sigrfum" -. Month Dry Yea <br /> 't, ter" <br /> TMnVomx2 RnWqypod Norms Signature -� MaM Day Year <br /> 18.Dkgeparoy..::. _ <br /> 18L oNcrepaxy Indication Specs omnoty ❑Type ❑Residue ❑PeAial R.P.H. ❑Ful Ra)edion <br /> Manifest Relervin bar. <br /> 1111xAlla als Facility(or Generator) U.S.EPAID Number <br /> U <br /> nQ- Fadby's Phone: <br /> Us 180.Signature ofIstemste Facility(or Generaor) - Month Day Year <br /> mV.Hazardcros Waste Repot Management Meeod Coda(La.,codes for hazardous waft treatment,dsposal,and reWding systems) <br /> 4. <br /> 21).Designated Facility Owner orOper roc,Cemloaon of receipt of hazemorre materials covered by the manifest except as noted in Item 18a <br /> ProterpTypetl me Month <br /> Day Year— <br /> EPA Form 8700-22(Rev.3-05) Preiloos editions are obsolete. GENERATOR'S INITIAL COPY <br />