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Please Print atype.(Form designed fause Melite(12.pfth)typowrfter.) <br /> t U 2.Page 1 Fo" pMecI.0MBN0.2D50-0M9 <br /> UNIFORM <br /> 3.Emergency Response Phone 4,Manifiest racking Number <br /> ,, 'i -�-ILI- -,%�% ( <br /> WASTE HAZARDOUS <br /> I I, "� I i I" ' ­ t 01 ' <br /> 4 <br /> -------mens,and"ang Address, 5384328 JJK <br /> L"C <br /> r—I F.; ...1 <br /> Generators Phone: <br /> 6.Transporter 1 Company Nam <br /> U.S.EPA ID Number <br /> 7-Transporter 2 Company Nam U4��X LE <br /> B.Deshinated Facility Name and Site Adtlress <br /> U.S.EPA ID Numbs <br /> Ge <br /> Generators T <br /> nspor <br /> 7 TE <br /> 8 De go <br /> 7 n I f7l 1 L, �I <br /> Fauldy's Phone:Ws N2_and <br /> Phone <br /> ar 1 C.-P. <br /> W 2 Corrine <br /> ated Fa.4ty Ne <br /> P� <br /> 7 t= iV-r k.,<"'C C') <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Nam,Hazard Class,ID Nurno,,, 1O.Contaners <br /> HM arid Pacting Group(Harry)) 11.Told 12 Unit 13.Waste codes <br /> No. Type Quantify WUVDI. <br /> 0 <br /> 3. <br /> 4. md <br /> ENVRON <br /> 14.Special Handling Instructions and Additional Information <br /> --- PF A�Cds <br /> T <br /> 15. GENERATOR'SADFFERDWS CERTIFICATION:Thereby ded <br /> an,itualthecontentsofthis cons7mm us fully and a=mtefy described abonn,by thapnoperslIPPffIg nanneandareclassfied,packaged, <br /> narked and iabelediplacamed.and are inall respects in proper condition for transport according to appy note international and naborail governmentalregulafiDnS.IfexPorishipmentandlarnbePrinnary <br /> Exporter,l certify Mat Me contents Of this c0rskJnm8m conform to the term of the attached EPAAcknondedgmento[Cmumnl. <br /> I certify that the waste minirrazatiDn statement identified in 40 CFR 262.27(a)lif I am a Large quantity gan a.11 quantity,gle for)s true. <br /> C,aneratcesnMroes Printecirryped Name Sigh eialre <br /> '—" Mom Day Year <br /> 16.international Shipment <br /> Ellmod to U.S. ❑DPW has S. Portofenilpes'l, <br /> Transporter signature(for exports only): <br /> 17.Transporter AclunoWedgmed of Date lewiv LLS.: <br /> of Materials <br /> W� Transporsu 1 P Name sit�na <br /> Dqy <br /> 0 -- <br /> M I ransporter 2 Pintedrryped Nam <br /> < S9 alum Ulh <br /> of <br /> Day rear <br /> 16.Discrepancy <br /> 16a.Discrepancy Indication Space El o..* DType ❑Residue ❑Partial Rejection ❑FIA Rejection <br /> I Mandest Reference Number <br /> 1 Bib.Alternate Facility(or Cenemlo) U.S.EPA ID Number <br /> M <br /> LL FacikVs Phone. <br /> 18c.Sigmuse of Alternate Facility(or Generator) monin Day Year <br /> 19.Hazallous Waste Report Management Medved Codes(Le..oDM,3 for hamrdws waste MustmeM,disposal and recycling systems) <br /> 4, <br /> 20.Designated Facility 0"o or Operator.Certification of receipt of hamrdws i apt as noted in Item 18a <br /> Printedflyped Name ng Wre Month Day y___I <br /> EPA Fonn 8700.22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INMAL COPY <br />