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Sep 04 09 03: 16p Lindsay Sc g „ � '' ' 9523389 p. l <br /> SEP Q 4 2009 Form Approved.OMB No.2050-0039 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 4.Manifest Tracking Number <br /> 3, prgen Response Phone (� p <br /> 1.Generator ID Number 2' `� q,Jt/II'U/; JNA. 'N U p <br /> UNIFORM HAZARDOUS aro EN' ' <br /> WASTE MANIFEST "•i. la(rf diflerent than mailing address) <br /> 5.Generalafs Name and Mailing Address <br /> Generators Phone: US.EPA ID Number .. v,.R.At�•�F� ,._ <br /> A.r.. <br /> 6.TransPoneri Company Name ..rc+as:,�.1"�,•,;,...r '.. <br /> • • "' U.S.EPA IO Number <br /> 7.Transporter 2 COmpanY New <br /> U.S.EPA ID Number <br /> B.Designated FaciBtY Name and Ste Address Si.T^;..y (;:'!r �'ti;:s"t.f• <br /> Faalil sPhone: r 10.Containers 11.Total 12.Unit <br /> 96.U.S.DOT Description linduding Proper Shipping Name,Hazard Gass,ID Number, 13.West Codes <br /> Mand Picking GwuP(if anY)) No. Type Quantity WtNd. <br /> 0 <br /> a <br /> w <br /> 4. <br /> 14 Spacer HandlingInstructions and Additional Information - <br /> 15. GENERATOR'SIOFFEROWS CERTIFICATION: I herebydeGare that the contents of units consignment are Sully and accuralelydasaibad above by the proper shippirgreme,arcane rdassi8ed,packaged, <br /> marked and labeledfplacardedand are in all respects In proper condition fortranspart according to applicable intemadoral and national governmental reguebons.If eaPod shipment and I am Ins Primary <br /> I as*q I centty that the contents of this consignment conform y the terms lithe attached Euanli,------ <br /> ment of Consent. <br /> I cerBfY dot Ne waste minimization statement identified in 40 CFR 26227(a)(if I am a Inge quanmy 9enerala)or(h)(if I am a small quantity geneator)is W e. synth Oay year <br /> GeneatarslOflerors Prinledrtyped Norma <br /> Signature <br /> J 16.Inlemational Shipments ❑Import a U.S. ❑ mExportfroU.S. Port of entry;axit: <br /> "r Date leaving U.S. <br /> Transporter signature(far exports only): <br /> W 17 Transporer,AckEMj -entof Receipt of Materials on Day V¢ar <br /> F— TanspOrter 1 Pnmedrryped Name Signature <br /> O <br /> � Monty Day Veer <br /> 2Q Transporter PrimedlTyped Name Signature <br /> K <br /> F <br /> * I8.Discrepancy <br /> I Ise,Discrepancy Indication Space ❑Type ❑Residue ❑Partial Rejection FUN Rejectlon <br /> ❑ Quantity <br /> Manifest Reference Number'. <br /> U.S.EPA ID Number <br /> 18b,Alternate Facility(or Generator) <br /> J <br /> U <br /> la+. Facility's Phone: Monty Day Year <br /> o 1Bc.Signature of Alternate Facility(or Generator) <br /> w <br /> z <br /> � 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazerdom waste treatment,disposal,and recycling systems) <br /> W 4 <br /> H t 2 3. <br /> v <br /> 20.Designated Facility Ower or Operator:Cer ifma8on of mceipl of hazardous materials covered by the manifest excepi as noted in Ilem 1 Ba E <br /> Il Printed4yped Name <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. .�E4'7EF.ATi'^ii'!^9;dES'faL Com:":" <br />