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Aug 17 10 10:13a Dawn Wickman 715-698-3485 P.1 <br /> Please print or type.To", designed for use on elite(12-aitch)typewriter.) " Foam Approved.OMB No.205MO39 <br /> .GsnemtarlD Number 2.Page 1 ol 3.Emergency Response Phone 4.Mandesl Tr c g�+r bar <br /> UNIFORM HAZARDOUS 0 p�, i 368 JJ K <br /> WASTE MANIFEST I <br /> 5.Generatoes Name and Madng Address - Gendmtpfs Site Address(itwerem man mailing address) <br /> tanrSl�n F chitty C'iiv`Es <br /> 57-50 V2 ITC?i0 <br /> TaP11-1Y,C?. <br /> Greoator§Phone: '22-E'-SLT-ns[Ut' US.EPAID Number <br /> 6.Tmmpa*1 Company Name <br /> Geedt a E~l, .iii4. <br /> 7.Transporter 2 Ctmpe Name U.S.EPA ID Number <br /> 8.Designated Facility Name and 5iHIM ss US.EPA 10 Number <br /> LFii RLCfi.9q.ti'. ro1Cre.i•1: t RP.• tx:r.5' <br /> 1,51 t439aF W. <br /> Fai Phone: 71,°.6 '-8X3 <br /> ga. 91h.U.S.DOT DesCipllon(Inq.dng PrCPW Shipping Name,Hazard Cass.ID Humho, 10.Canmirters 11.Tool 12llrit 13.Waste Codes <br /> HM and Parking Gmup;Wany)) No. Type Quantity WIIVd. <br /> 1' hp_P'1 F.Ci?q t1r*,2EF:30!!.� `xb:A.3'Tr�- SOi.iD 'Di. +6uf0eF '35�; _ `�' <br /> 2-- ('00 <br /> z 2. <br /> W <br /> a� <br /> IF <br /> a. t;t QiYk le 0� <br /> 14.Special Handing lrrsWclions and iuorml lnfome:bn <br /> USE:Gtwa/E3 , <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that me contents of this consignment am tufr/and accurately described abate b thepmper shipping mi m amciassieed,pac'raged, <br /> markedandlabeledfplecarded,anderefnadreapecm Inpmpercondiuonfortwsponaccofdngtoeppimblelnte iDmlandreSmalgmemm ntalregulationa.lfexportshiprnemandlemthe Primary <br /> Experux,I o roily that the cements of this consigrxnenl conform m be terms at the attached EpAAcknovledgment of Consent. <br /> I ceruythatthe waste mman¢afon slalement lden`,Ified to 40 CFR 26227(a)(8 lam a large Quamtlty genemtor)a(b)tilt am a small bunny ganemlo)is tun hlnnm Day Year <br /> GenemnislOflerors Primtad`yyyed Name Sgmture <br /> G <br /> Y 16.Inlematicnal Shipmen5 UInponto U.S. ❑Expan lrom U.S. - Portotentrylexit: <br /> Tmnsponercigralum Qor exports only): Dale leaving U.S.: <br /> K 17.TmnsporlerAdgKWedgmentolRecalptofMatedalA Monro Day Year <br /> TmrsepOrlerl PdnletllryPed Name Signature <br /> y -Q r - Ye <br /> Signatur -i% .. f. Monro ' <br /> Tmnsporler2 'nte .Typed Nama <br /> Iz � I�xS <br /> r <br /> 18.Discrepancy <br /> 18e,Discrepancy Indicaton Space ❑ ati ❑7ypa LJ Residue ❑Prual Rejection ❑Full Reje3on <br /> McNlesl Referenm Number <br /> 0.S.SIg11D Ncmber <br /> 1.8b.AMernate FaC!11 y(or Genemmr) <br /> J <br /> U <br /> tai Facluyk Phone: Ncnm Day Yrmr <br /> w 16a.SigreMremAeemale Fatilicy;or GenembrJ <br /> 4 <br /> a <br /> S2 19.HareMas Waste Report Management Mehod Codes(ie.,codes far heaardous waste treatment,disposal,and mgdng systems) 4 <br /> our 1 2. 3: <br /> o ' <br /> 20.Designated Fadfy Owns,of Ope-ato:CertAcatim of msipt ofha�rdovs rreferah ousted by the manifest exceplge d+wl 18e r y�gr Day Year <br /> PAnledCyped Name Slsirmt4ra % <br /> EPA Form 8700-22(Rev.3 5) Previous fion are obso'ele. ESIGNATED FACILITY Tb GENERATCi1F <br /> 7 . <br />