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Sep 04 09 03: 16p _ Lindsay Schwager 2099523389 p. 2 <br /> Form Approved,OMB No.2050-0039 <br /> Please print or type.(Form designed for use on elite(12-pitch)typevinter.) 2 Page 1 of -E, g! Responu Phone 4.Manifest Tracking Number G g F <br /> UNIFORM I{pZARDOUS 1.Generator ID/N1u'm!ber t� ry 7h 0•"';q i 7 - 17 <br /> .a -•° •T - <br /> WASTEMANIFEST Worn t0rf�✓ r��`a'y it 7 - ' � <br /> 5.Generators Name and Mailing Address?ter Generators Site Adtlress til di6erent Nan mailing ad ninnil <br /> Gera mters Phone: (< � s, U.S.EPA ID Number <br /> 6,Transporter 1 Company Name 1IIf{f�nnnn�Q7+`.� <br /> f'I llt l.V vvv�.ia a,r <br /> CRI Recycling Service IIIc u.s.EPAID Number <br /> 7,Transporter 2 Company Name <br /> U.S.EPAID Number <br /> 8.Designated Facility Name and Sile Address t 1J�CioAdl,n�'J['►'7 +� <br /> R8 Rec ci :r a serxice int rf Tl 00029 <br /> 1L11 ±-lagen Dr <br /> Facility phone: WoodAle, W{ 5482£ EKDC-241 <br /> 10.Containers Total 12.UFA13.Waste Codes <br /> 9b. <br /> ga U.S.DOT Description including Proper Shipping Name,Hazard Class,ID Number, No Typo Quantity WLNd <br /> HM and Packing Group of any)) Qu r <br /> 2. <br /> z <br /> � r <br /> r <br /> d. .._-1----.— <br /> 14.Special Handling Instructions and Additional lMormation F- -C3•-.�,'� '171 <br /> Wear Protective C'it?thing and Eyevrea-.. <br /> 75. GENERATOR'SIOFFEROR'S CERTIFICATION: Thereby declare that the contents of this consignment are fully and acmratelydescribedabove by the proper shippingname,and are dessifted,packaged, <br /> marked and W'SIOFF ROR'S,and are in all respec01ti proper condition forlm^sport acceding to applicable intemationaland natlanal governmental regulations.If export shipment antl I am the primary <br /> Exporter I calmly that the contents of this consignment conform to the terms of the attached EPAAcknovAedgment of COnsard. <br /> I certify that the weste minimization statement Identified in 40 CFR 262.27(x)(it I am a large qui nay generator)or(b)(III am a small,,yantity 9eneratorl is true. month DW Year <br /> Signature 'a - /•' <br /> GeneraWy9108erors PrinkdlTypetl Name <br /> 6 International Shipments ❑Import to U.S. ❑ExpM from U.S. Pon or a aryhexb: <br /> r- Date leaving US: <br /> Transporter signature(for exports only): <br /> w 17.Transporter AcknwAedgment of Receipt of Materials - month Day Year <br /> Transporter 1 Prinie/drryped Name f <br /> jy`P: :r.j tij j Monm Day Year <br /> z Traner2PdmedRypeo Name Signature <br /> mspoi <br /> 6 <br /> 18.Discrepancy <br /> 18x.Discrepancy indication Space ❑ Quantity ❑Type <br /> Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b.Altemate Facility(or Generator) <br /> J <br /> QMonth Day Year <br /> LL <br /> Facility's Phone. <br /> w 18t.Signature of Alternate Facility(or Generator) <br /> Q <br /> I,and recycling systems) <br /> H19.Harardws Waste Repot Alanagement Method Cedes(i a.,codes for hazardous waste healment,dispose Yd� 94 <br /> o ' <br /> ([! <br /> 20.Designated Facility 0er^r Operator Certificate,of receipt of haUptOus matenals covered by the manifeat eaev,as need in Item 183 Month Day Year <br /> Signature <br /> PrinledRYPad Name <br /> EPA Form 8700-22(Rev.105) Previous Wilma are obsolete. <br /> s�E:,'�:ri,^`:.:'�fh l-,.C.W_"-„:•c:Y r�]l!'ES?.^.;'�n';""�: ..=�,.. .' ,.. <br />