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Aug 17 10 10:14a Dawn Wickman 7],`g-698-3485 p.3 <br /> Please print ar type.(Form designed for use on este 12-pitch)typewriter.) F'rm Apprcved.ONIB Na.2050-OC39 <br /> UNIFORM HAZARDOUS 1.Generator lD Number 2.Pagel of 3.Emergency Response Phos 4.N/a�nif(e}sl Tracking Number <br /> WASTE MANIFEST - •; _<... 005 44838 JJK <br /> 5.Generaytor's Name and Melling Address GeramtaM <br /> r's Site Address(g dlfierethan mating address) <br /> LIVGCD FiiPdii., rJU✓C_ <br /> �7c_50 Via MC04 <br /> GaneraWs Phone: <br /> S.Transporter l Company Name f U.S.EPA ID Number <br /> GeOrge V4 LOWr ,talc C't'Fi4c: 6 col <br /> 7,Transporter 2 Company Name US.FPA ro Number <br /> t 1 r' �nafi�.�;n•.ya <br /> 8.Desianatai Facility Name and She Address U.S.EPA ID Number <br /> CRI RCC;Y11artq SB-flGE I'L' <br /> 10{ H=car:Dr. <br /> Fadlltysi;tw'hle,'vv! S•Y::x <br /> ger lb.U.S.DOT l5emplim Qnrkuding Proper Slippig Name,Hazard Waw,ID Number, 10.Containers 11,Total 11udl 13.Weals Codas <br /> HM and Pecans Group gl aro)) No. Type OuanMy W[Nol. <br /> xY <br /> p 'tee:ATE SGUO {Oli'Y <br /> 1-00 <br /> w <br /> • c� <br /> 3 CERTIFICATE <br /> OF RECYCLING <br /> 4 <br /> BY— 'L. ............DATE.... !Cd <br /> '4.SpecialHadling lnstrucdcas and Additional lnfolmafim <br /> ERG r:1.71 <br /> WECR GLOVES <br /> 15. GENERATOR'WOFFEROR'SCERTIFICATION: I hereby declare lhat the coolants of this wnsignmard are foly and accurelely described above by the proper shipping name,and are classified,packaged, <br /> marked and tabekdrplararded,and are In all respects In proper condition for banspoh according to appli able irusmaionalard national governmental rer"bms.If export Shpment and I am he Primary <br /> Exporar,l Mnify hat the mntenm of this consignunem cadorm to the terms of he attached EPAAcknowadgment A Consem. <br /> I tartly the:he waste n rmheation statement idenilfied In 40 CFR 282271a)(t I an a targe wandty generator)or(b)Of I am a small puaniky generator)Is but. <br /> Genamlors/ORarors FdrdedrTyped Name Sgnatnae rAow Day Year <br /> / f <br /> 16,InEornatioral SN enter <br /> ❑Importb U.S. ❑Expodfran LLS. Pad ofentryaxh: _ <br /> Y Transwrtersignalure;forexpods only}: Date leaving U.S.: ` <br /> W 17.TransporlerAck oWadgmaM of Reeelp'ol Maledals <br /> Trarsporar 1 Prhmd(Typed Name Signature Month Day Year <br /> 0 yr, <br /> CL SCOT,'MCCLOU0 i2 1t <br /> C7mnsponar2 Pnnledflyped Name Signature Manta Day Year <br /> LZ <br /> W41�11;ij 7/ <br /> } 18.Discrepancy <br /> 182.Discrepancy Indication Space ❑ OuawTy E]T . ❑Residue El Partial Rejection ❑Full Rejection <br /> Manifest Relevance Number. <br /> 184.Atemaw Facility(a Generator) U.S.EPA IO Number <br /> V <br /> Facliy's Phone: <br /> w 'Sc.Signature ofAilemate Fecllay(a Genemb') Monty Day Year <br /> 6 <br /> z <br /> V; 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Imatmenn,disposal,and ratting systems) <br /> 3. 4. <br /> j 20.Deslgnated Facility Owner or Operator:Certmra on of receipt of harwdous malacias covered by the rankest din Ilam Be <br /> PrmtaNTyped Name Signa Monh Day Year <br /> D LL Q <br /> EPA Fom8700-22(Rev.3- 5) Previous edi' ns are obsotete. DES104ATED F 1UTYTOGENERA R <br />