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From: . 08l 010 19 :40 #453 P.0011002 <br /> Please r&Vr+9pa46ormdesignod for use on elite(Q-pitch)typewriter.) Form <br /> UNIFORM HAZARDOUS i.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tree let;Number OMB No.205P0039 <br /> WASTE MANIFEST (' Illlit4:4.1:1 S: - t H41, i.'r r tt i e f '! " '°" G B F <br /> 5.Generators Name and Mailing Address GanaraWrs SIIeAdE.(if different Wan mailing adtlress) <br /> MU£i.()f AhfIj.'i<7U'v"i:. t f;ht!`APar <br /> I 7P:iU MA ISL Of.0 <br /> 1 ftt.f Y.4A <br /> Generator's Phone.tfjf4 <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> :;I JT4 IIA.A.P?f)tx 80I.L1i I()PfS {.A1kJf111fxd&4i•:sl <br /> 7.TranapMer 2 Company Name U.S.EPA IO Number <br /> 8.Designated Fadiry Name and Site Address U.S.EPA ID Number <br /> taf•hf-f3AP1"t4r7 f'(1i?Ek.iVfi•,l l{ <br /> I t Bsi6 MA-61 f:twkf+41). CIAO P1Bit•710-A <br /> R,A"C.W)4;Cdf7Cfs'.P A.CA U ids <br /> FadIRl+z Phone: Nt fr:451CfSAt <br /> 9a. 9b.U.S.DOT Desorption including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Padino Group PI enyll No. Type 11.Total 12,UMI 13.Waste Codes <br /> Qui aArra. <br /> rc I. tIAZ4f°1DC}4.Iti VJA51E MCHC.I10 S 6.f'ffa.107• .fit I M7P4 ��f` r' U17{}7 � f]U68 lot <br /> o ti�?htuYlB f k AE 1 tQtK17.C'f 1f1 <br /> w <br /> 3. P <br /> a. <br /> 1711 <br /> 14.Speciai Handling instructions and Additional Infomalian <br /> f l;r.YekLL iW ?Ott ,WE I.At.ti4fnJW5&WI11i t.`.ffft['f4llfvl j I FAL) ItsC�(f <br /> ARf'r42.)f+fkr.7AtE:F'f?i.sl'FCTfe'E(;E.t'J1ffff?i <br /> SEE FRG <br /> 15. GENERATORSIOFFEROWS CERTIFICATION: I hereby dedare that the contents crime consignment are fully and acamtaly desaibad above by the Proper shipping name.Ord ars classified,packaged, <br /> marked and lebeleciplaarded,and are in all respects W propel condition for transport according to applicable intemalbnsland national governmental regulations.It expod shipment and I am the Primary <br /> Exporter,I edify that the contents of this consignment conloim to We terms of We attached EPAAcknowledgmant of Consent. <br /> I cengy that me waste minimization statement identified in 40 CFR 262.27(a)(81 am a large quantity generelur)or(b)(yl am a small quantity generator)is uue. <br /> GenemWr6/Ciffeme Prm "y'pja�)�Iame Sigriaallum Month Day Year <br /> 16.International Shipments t <br /> F ❑Importto U.S. Export from U.S. Port of anbylexR: <br /> Transporter signature for exports only): Date leaning U.S.: <br /> 17.Transports,Acknowledgment of Receipt of Maienals <br /> Trensporter 1 P' ed/TypedAName �z'' �^ Signaturej, MonW Day Year <br /> Ic <br /> Z Transporter 2 PrnledfTyped Name Signature G <br /> ¢ MonW Day Year <br /> F <br /> I <br /> 16.Discrepancy <br /> 18a.Discrepancy lndicegon Space Quantil ❑Type Residue <br /> Y []PanelRejection ❑Full Rejection <br /> Manifest Reference Number, <br /> 18b.Alternate Fadlity(or GeneraWr) U.S.EPA ID Number <br /> J_ <br /> V <br /> u Facgity's Phone: <br /> 18c.Signatum olAllernme Facility(or Generator) Month Day Year <br /> Z <br /> 2 <br /> N19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste Vestment.disposal,and recycling systems) <br /> p1. 2. 3. 4. <br /> 20.Designated Facdiry Owner a Operator:Certification of receipt of hazardous materials covered by the manifest except,asaded in Item 18a <br /> Prime ped, me ! j Signature - � enth CrY /Year <br /> EPA Form 8700-22(Rev.3.05) Prevl s editions are obsolete. '": . _ <br /> DESIGNATED FACILITY'S COPY <br />