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Please print or typo. Form designed for use on elite iQ-eflch)lypevirdlar.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 GamrMa Number 2,Page 1 of 3,Emergency ResponsePhone 4,Manliest Tracking Nhmber <br /> WASTE MANIFEST C14 loonigt4mo I oa —5oz 015384315 JJK <br /> 5,Generators Name and Moiling Address Generalnh She Address(if different man mailing address( <br /> i?�►�SyS Glass fkor,Fssr�lla c(5�15 <br /> S S I�Jc\w�vL VslV&, 5 O00I�TON G� <br /> GerremmrsPlrone: '1041 TTLI —,50 <br /> B.Tmaypddnr 1 Company Name V.S.MID Number <br /> sT O <br /> 7,Tmm;zvp f2Omwrvy Nlvm U.S.EPAID Number <br /> 8.Des"Itud Facility Nam and Spm Address U.S.EPA ID Number <br /> -9-11 )\1 q6; 1 MkL(5 sen .OF 66fa-W11, "Y 1\)Ev,9Dw 9Ct0C)3 <br /> radii 05 Phone: 660-132—.52Y3 I NVVT to oo <br /> ger 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 10,Come an 11.Tolal 12.Unit <br /> N <br /> HM and Packing Group Qfeny)) o. Type Quantity W(Nai. 13.Waste Codes <br /> ' <br /> Nw 30��11dVi zW R Dov 8 a96T�f 6 _UV <br /> w X sou)o, N•0.5 g -Zit 2 crap \ 0 616 <br /> z 2. <br /> w <br /> 3, <br /> 4, <br /> M=AL <br /> 14.Spee a log m¢IrucUons andA—Riionsl lmorma8on <br /> Ml)V-,'D CAMW( 10 C�A\jLovtfJs <br /> 15. GENERATOR'SIDFFEROR'SCERTIFICATION:I hereby declare that thecumenls of this ennslgrvrrenl are fully and eceuretetydescribed above by the proper shipping mama,and are classified,packaged, <br /> marked and IabeleNplacarded,and are In all respecter in proper condition for beneporl according to appricabla Mlomatlonal and national goverrmenlal regulations.11 expod shipment and l am the Pdmeny <br /> Exporter.I¢adify that Re contents of this consignment conform to the how of the atlached EPA genital, - and. <br /> I cerily,that the waste minimization statement mondled In 40 CFR 2"(n)If l am a large quanllly'ggieev!)', ,) l am a small quantity generator)is We. <br /> GenmewslOffor PMwdgype arm .. . Spgnp Mwdin Dry Yaat <br /> ,CO - , ©I l <br /> iG.interna8onal ip nus <br /> ❑Mport to U.S. ❑Export from U.9. Pad alenlrylexN: <br /> Transporter signature(far exports only): Date leavbg U.S.: - <br /> 17.TransporterActmoWedgment of Receipt mfMaboorrals <br /> R4nzp <br /> ndor 1 Prink6TyPed Nal C-.5-T- <br /> .�^� ION +'"f (n A, Signa Mark Ogay� Yaor <br /> � 'V oCI 6 <br /> N <br /> Trpnspo'ler 2 Pdn y Nwne Signature EbnIA Day Year <br /> 10.Discrepancy <br /> 10a.Discrepancy Indication Spare El <br /> Quantity ❑Type ❑Residue ❑Pallial Roledien El Full Releclbn <br /> > Wriest Whipsaw Number: <br /> F- I Bh,Ammnpto Facility(or Givam!or) U.S.EPA ID Number <br /> J <br /> LL Fer841APhone: <br /> w 18a Signature,ofAnanme Facility for Generator) Month Oa y Ycar <br /> z <br /> V5 <br /> rn 19.11azardoeekkasu Repod Man agement Method Codes(t.e.,codes fahazallouswastetrumanenl,disposal,and recycling systems) <br /> 4. <br /> l'3a <br /> 20.Designnted FaNity Ownsror Opema :Ce_ ion ofetmpl of hazardausmaterhls covered by the manifest except as need In Ilam His <br /> i <br /> Prilwyped Naa SOG y ear <br /> � ) I( lot ilia <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATIOP) STATE(IF REQUIRED) <br />