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L�.YIASTEMANIFEST <br /> .(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> ZARDOUS i_Generator lO Number 2.Page l of 3.Emergency Response Paine 4.Manlftlsl Tracking Number <br /> NIFESTJJK <br /> me and Making Address Generdlols SAB Address Qf dt8ereof than madhip address, <br /> w: Nm U.S.EPA ID Number <br /> 7.Tnreporler 2 Company Name U.S.EPA ID Number <br /> j.; 8.Designated Fadaly,Name and Site Address U.S.FPA IO Nuaneer <br /> y <br /> f.., 9a, 9b.U.S.DOT Description(mduding Proper Shipping Name,Heard Class,lO Number, IO.Containers11.Total 12.UnitHM andRiolug Group(if any)) No. Type Quantity MAIN. 13.Waste Codes <br /> O <br /> .I <br /> r W <br /> f7 <br /> I <br /> 3. <br /> 4. <br /> Y <br /> 14.Special Hard ng lnsnclions and Additional lnlmmaaon <br /> { <br /> 16. GENERATOR'SIOFFEROR'SCERTIFICATION:I hereby declare that the contents of he consignment are July and accurately desuibed above by the proper shipping name,and are classified,packaged, <br /> marked and tabeled/pmcaded,and are in all respects in proper condNon for"report according to applicable International and national governmental regulations.If export shomead and I am the Primary <br /> s Exporter,Icrity that me mn;ents of he wnsgmnem coMotm to me corms of the allached EPA Acknowledgment of Conserv. <br /> ,•€ IceNfy that the waste rrimmmauon ssement:McNifed in 40 CFR 262.27(a)(I l am a large quantity generator)or(b)(if I am a small quantity generalo)is true. <br /> a 1 Gerremlo'elOffmc,'s P inWyped Name Sgnatoe Alarm Day Year <br /> .� 16.Intwralional Shipments <br /> �� F ❑Import to LLS. ❑Export Bon U.S. Partafenirylaxil: <br /> .� Tiarower sipature(for exports only): Date leaving U.S.: <br /> w 17.Transpo AcknoyAedgmeotof Receytof Morelos <br /> iTransporter 1 Pnnted/fyped Name Signature Mont. Day Year <br /> 6 <br /> CTransporter 2 Pnntedrfyped Name Signature Monm Day Year <br /> rc <br /> r- <br /> i16.Oisaepanq —I <br /> 16a.0iurepemy Indication Spam ❑ Quenbty ❑Type ❑Resdue ❑PaNal Rejection LJ 1`01 Rejection <br /> f0anifest Reference Number: <br /> Z 181b.Allemale Facility(or Generals) U.S.EPAMNumben <br /> CJx,sa <br /> saL Fac lys Phone: <br /> ttf Qy�j 1lic.SigraWre ofAHemale FaUity(or Gibraneo) Month Day Year <br /> I 2 <br /> 1 S2 19.Hazardous Waste Report Management McRM Codes(i.e.,COM for hamdous waste irexlmef4,disposal,and recycling systems) <br /> t. 2. 3. 4. <br /> 20.Desgnsted Fapfity Purer a Op into:Cantrim en of receipt of hazardous materials covered by the marvfest except as noted in sem 18a <br /> l <br /> rRatifyiew Name Sgrowne Month Day Year <br /> �( EPA Form 8700-22(Rev.3-05) Previous edi8ons are obsolete. GENERATOR'S INITIAL COPY <br />