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VIM IF, "Lvr <br /> Form Approved.OMB No.2050.0039 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewdte4) <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A (') 9 t1 Z 5 J 2 .�- J 1 909.88x3-�e843! 003214613 JJ K <br /> 5.Generator's Name and Mading Address Generators Site Address(H ditferent than mailing address) <br /> Unified`Nmst6rT1 Craters IJ W G. <br /> ABUT Pal CxAWmPty,5210 Sixslia 9ttp...e'1 1SM30 Pk,'c04 Rd <br /> (:Of1YTwc°53 twA 1)W47 y1M:ktCNi 4:A :i',}`[i',` <br /> Generator's Phone: a j5 A " U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> U <br /> Haz Mat umbxn <br /> Trans,s, kir, i; A T b n 0 1 :t 8 <br /> 7.Transporter 2 Company Name U.S.EPA ID er <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> StAtnerc9t Weil IeecjVvA*6$COre <br /> 5:175 Swift Boyle pAve <br /> ry <br /> Facility's Phone: Ano 2W.-r7A7 <br /> ga 91b.U.S.DOT Description(inducing Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> HM and Packing Group lit any)) No. Type Quantity WLNol. <br /> 1' Ncm-RCRA, Ha2erdo 16 Wlaste g X52 <br /> � (aUflbetllLenf) ,, <br /> 2. <br /> K <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> •-1 t, ) � 111. '�If.,. .•-),rtirt tl .,,_,� :. '. .. .. c ; ..',a . , _ <br /> 15. GENERATOR'SIOFFEROR'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 labeledlplacarded,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,l certify that the contents of this consignment conform M the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(x)(d I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generstor's/ORemrs PdntedRyped Name Signature Month, Day Year <br /> 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Pod of entryland: <br /> = Transporter signature(for exports only): Date leaving U.S.: <br /> K y'".�{�'h y 1 ; <br /> IY 17Transporter Acknowledgment of ReceiptofMateria <br /> Transporter 1 Pnntecirryped Name tignaNre r Month) DaY Yeeel <br /> u .d + /1[ ? ;f- ,r t`'d 1;;T f P •d`..i-�.';'t_q. .�.av"s �'..f S£,• �'t':' <br /> .- f T T <br /> W, r r� Month Day Year <br /> Sot Transporter 2 PnntedyTyped Narre Signature <br /> 18.Discrepancy <br /> laa.Discrepancy Indication Specs ❑ Quaintly ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> r <br /> U <br /> LL Facility's Phone: Month Day Year <br /> w 18c.Signature ofAllemate Facilily(or Generator) <br /> Q <br /> 2 <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> 7. i 2. 3. 4. <br /> 20,Designated Facility Owner or Operator:Cerbkafion of receipt of hazardous materials covered by the manifest except as noted in Item 78a <br /> VIII PnntedrTyped Name Signature Month Day fear <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />