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Please print or type. (Form designed for use on elite (12 -pitch) typewriter. <br />Form Approved. OMB No. 2050-0039 <br />TUNIFORM <br />HAZARDOUS i. Gene ator lD NN bye[, , <br />.'�,Fl I...�.J.'<: c..• G= _i -'" <br />2. Page 1 of <br />J <br />3. Emerrgency Response Phone <br />FIGS:.' — ?t' <br />4. ManifestTmcking Number <br />009479243 J J K <br />WASTE MANIFEST <br />A. Generator's Name and Mailing Address+`rF/+r. r)� 4^a--4.; Generatofs Site Address (if different than mailing address) <br />Generator's Phone: i:L.yy�/- <br />6. Transporter 1 Company Name U.S. EPA `D Number y <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address ,4, aA+V+ ,t%d•('(e 145+ L.• i�/ U.S. EPA ID Number <br />15'7 IiA <br />Facility's Phone: <br />ga <br />gb. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Contalnam <br />11. Total <br />12. Unit <br />13, Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (If any)) <br />Quantity <br />WLIVOL <br />1. .VA.3c\•77 4Ai.Ft h:.aG.c:'3 <br />w2. <br />r1/A >;C77 /i{1 ,:: ti K'.,i-'C.. � G.✓ 'S G^� Gd. rcl <br />[:Y -C t: <br />r'7 <br />i!' <br />nf7 i G + <br />� <br />_ <br />3. <br />E. <br />4. <br />—� <br />114. Special Handling Instructions and Additional Information <br />r <br />15. GENERATOR'SIOFFEROR'SCERTIFICATION: 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 governments] regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment coMcnn to the terns of the attached EPAAcknoWedgmenl of Consent <br />I certify that the waste minimization statement Identified in 40 CFR 26227(a) Of I am a large quantity generator) or (b) (fit a small _quantity generator) is true. . <br />GeneratoestOfieroes PrintedfTyped Name Signs ,.• 'y �,+ Month Day Year <br />µ <br />16. lnternaflonal Shipments feng1eAt <br />❑Importto U.S. ❑Export from U.S. Pon <br />Z <br />— <br />Transporter signature(for exports only): Date U5: <br />K <br />17. TransporterAcknowledgment of Receipt of Materials z <br />�.. <br />Signature Mon <br />./ ?y 1Ye,@ <br />Transporter l Printed/Fypa(diJarae �% 3 tJ `� <br />�i C <br />y..I <br />�i j'77'i`,j"7VI LLL??? <br />4 <br />Transporter 2 Printedflyped Name Signa re Month Day Year <br />� <br />K <br />H <br />} <br />18. Discrepancy <br />I <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Resldue ❑ Partial Refection ❑ Full Rejection <br />Manifest Reference Number. <br />18b. Alternate Facility(or Generator) U.S. EPA ID Number <br />J <br />V <br />LL <br />Facility's Phone: <br />18c. Signature ofAltemate Facility (or Generator) <br />Month Day Year <br />aWa <br />z,19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recycling systems) <br />-.�• <br />1. <br />2. 3. <br />4. <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted In Item ISE <br />♦II <br />Pnntedrfyped Name Signature Month Day Year <br />EPA Form 8700-22 (Rev. 3-06) Previous actions are obsolete. GENERATOR'S INITIAL COPY- <br />