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Please print or type.(Form designed for use on e'Ihe(12-pik:h)typewriter. Form proved.OMB No.2050-039 <br /> U==us 1.Generates lD Number 2Pagelof S.Emergency Response Phone 4.Manlleet'hacking Number <br /> WASTE MANIFEST (i 2 i �_77Y-5, 0108 75069 JJK <br /> 5.Generetoes Nameand MalligAddrem r / Generator's Sile AOtlresr(N cram rhe mailing address] <br /> ECS (�Fl N I ri u-- 2Z;L2 S .f S-106k TO t CW. <br /> Gerwremrs Phone <br /> 7 — OOc7 <br /> 6.Transporter Co ny flame- t, U..SS...EPPAAIIICTRumber <br /> 7,Transporter V <br /> po Company Name U.S.3A IL Number <br /> ENV(IL-orylE&tr9L Wi-, 5 $�a2yrc�S I l-t14nQ39,52-2-2-:,-5-0- <br /> 8 <br /> .Designated Facility Nam and Site Address <br /> � US.EPA IDumber <br /> &t-To,&)W1LL-OL, GA- 137©6 Tf/irAr/ <br /> Fact s Phone: `^ ,00 <br /> ga. 9b.U.S.DOT Description tndudng Proper Shipping Name,Hazard pass,11 Number, 10.Corlainers 11.Total 12.Unit <br /> HM and Packing Gmrq(if arty)) 13.Waste Godes <br /> No. � Type QuantityWINd. <br /> Y bW'( fJO u -12U2PC r RIMOW-00 w5 L`{� 1 <br /> wd2 2r77'2r ----- = - <br /> W r <br /> t9 r r <br /> I <br /> r <br /> 3. <br /> i <br /> 4. ��— <br /> i <br /> r <br /> I 1 <br /> 14.Special Handling Instructions and Additional Information <br /> Weep PA oZ4 o g (ctt 6a",cq 2 '�-P yLo w-5 <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the mnrems of this consignment are fully and eccumately described above by the properehpong name,and are classified,padaged, <br /> marked and labeled/placarded,and are W all respells in proper condlim ror transport aaordng to applicable intemaaorW and national governmental reg rations.dexpm shipment and I art,the Primary <br /> Exporter,I ceNfy that the contents of this contignment conform to the terms of the attached FPAAcknowatlgment of Cmsent <br /> 1 cedlfy that the Waste minimlzaeon statement Identified in 40 CFR 252.27(a)(91 am a large quantity,gena ator)or(b)(if I am a smell quantity generator)is true. <br /> Gmeretoes/Ogerofs PrintedfTyped Name SignaWre 12 MUM Day Yea <br /> J 16.International shipments <br /> 1— 11 Import to U.S. ❑upwt5om LLS. Podofentrym rt <br /> = Tareporter signature(for exports ohiy): Date leaving U.S.: <br /> w 17.TransporterArlawwledgmentafReoelpl of Matelots —� <br /> O <br /> Transporter 1 Pmrtedrryped Name Signature <br /> _ Mmth Day Year <br /> YqA dl)7-421 <br /> 1 <br /> aZ TransDortar2 PrimteNTypetl Name Sigrralu / Month Day Year <br /> of <br /> 18.Discrepancy F <br /> 18a.Discrepancy Indication Spare ❑ouan9ly }pais _ 3 DR&f. ❑Partial Fejection ❑FW Road. <br /> 7[11,A4anifest Reference Number. <br /> 18b.Atemate Facility(or Ganeralm) U.S.[PAID Number <br /> J <br /> ram Fadiys Phone: "c>;n.f? F: •. ' <br /> lk Signature ofAltemate Faclify(or Generator) Month Dsy Year <br /> 4 <br /> z _ <br /> 05 19.Hazardous Waste Report Management Method Codas(i.a.,codes for hazardous waste treahnard,disposal,and recycling systems) <br /> 1. 13Z 2. 3. 4— <br /> �— <br /> 20.Designated Facility OwnerorOgejatm Certification of receipi of hazani materials covered by the manligLaxo9p4eawela ' It n A <br /> ri aturMonth DayTee; <br /> q _ 117- IZ9 / <br /> EPA Form 8700-22(Rev.3.05)Previous edAionsare obsolete. „IG /�. FACILITY'rO DESTfl3MON STATE(IFr REO.UIRED) <br />