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Please print or type.(Form designed for use on elite(12-pitch) pewriter.) Form Approved.OMS No.20540039 <br /> t.Generale ID Number 2.Paps 1 of 3.Emergency Response Phone 4.n('� Tr ` NwrAw <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST �7 E o 9 3 JJK <br /> 5 Generators Name sine Melling AM2ss Generator's Site McRae$IB deal Nan mailing addreesl <br /> Gener <br /> elNs Phone'. U.S.EPA ID Numoer <br /> 6 T 118 1 Company Name <br /> G�1k r4= - <br /> .. <br /> 7 Tranemner 2 Compery Name <br /> 6 Dngnet00 Facility Name,9M SM Addrou U.S.EPA ID Number <br /> .Lavil a Rams <br /> BeBo.U.S.DOT Dualpwn linduong Proper Shipping Name,Heard Claw,ID Number, 10.colwh om 11.Tota 12.Unit 13.Waste Codes <br /> . N: Type Quantity WIW6 <br /> HM and peeking Group(H any)) <br /> 1. .. .. <br /> C <br /> OQ <br /> a' <br /> z 2 <br /> w <br /> cD <br /> a <br /> 14.Special Hand ng Imaruceone and Addwnal InfonnaWn <br /> r1, c I ;1lw 141pf(Y..xfmPf''T-' <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION'. I heresy declare Nat dre contents of Nis mnsignmeni a2 tully and acwratey wsmb above by Ne proper Bhippng name,ad are dassilad,packaged. <br /> markw and mbeleciveacameo and are in at respects in paper coMilion for transport accordeg is applicable international end natg4 gevemmenra:regulationsif export shipment and I am the Pnmary <br /> Exporter,I Mey Nal Ne comma of Nis wnsignmenf mnrper,to the temp of am sheeted EPA AckmMedgmenl of Consent. <br /> 10@"Vale a*sea,mnanuanon staNmem identified in 40 CFR 262.27(a)(a I am a large quantity generator)or(b)(aI am a small quantity gel"ill 5 true. <br /> ginaWsCifemes Printedrryped Name Slrapse Maeh bey Yea, <br /> a <br /> J 16.Intematlonel Snipmems ❑hnp M to U.S. El <br /> from U S. Pon of enterymna: <br /> 2 <br /> Transporva s"wee)for exports only] Date leaving U.S.: <br /> K 17 Trarrpater Ackn0sledgmem of Receipt of Materials <br /> KTnemperin 1 PontedrTyped Name Sgnature Monty Day Year <br /> O <br /> Z Transponer 2 PnnbdrTyped Name Signature Monty Da} Yea, <br /> w <br /> 16.Discrepancy <br /> tea Discrepancy,mdicemen Space ❑ Qusnmy Type Residua ❑P."Refection ❑Full Re;ecsor. <br /> MW*MRO*WMMNAW <br /> 16b.Aherne*Fanlay lc,(3,nerator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Pinions <br /> w 16c.Signature of Anemate Fsomy(a Generator) Month Day Year <br /> Q <br /> Z <br /> 0— 10.Hazardous Waste Report Management McNoO Coda(i e.,miles b hazardous waste treatment disposal.ane reeytlirg System) <br /> W 2, 3 4 <br /> O <br /> 20 Des"M Faa'M a'^lK Of gator.CeNfira6°n of MOW Of hazardous materials covered by Na martl(wt except as now in nem 18a <br /> 1 FlMgWTyped Name Signalum Momn Day Year <br /> EPA Forth 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />