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Please Ddnt or lice. (Form designed for use on elite (12 -Ditch) typewriter.) 1549 jQa '72Z�.. Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) PfeftMs editions; are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF,REQUIREO) UNIFORM HAZARDOUS I. Ge ator ID Number. - ' WV;Vv 3060 - 2. Page t of I 3.. metgenc .Response Phone 4. Manifest Tracking Number 003931415 FL E WASTE MANIFEST 5. G e is ame a Mail In d s Generators Site Address (if di erent than mailpg address) S2 Awrorr�a y� co3 �'y5. st Die Mj.At ajn �J�'CG4��t1 V -L "I ZV � e. • 8 pn rter_ aVq✓1 Cn� ma lir I L r7✓l5 EPA ID Number x�q�� ,/y., 7. Transporter 2 Company Name U.S. EPA ID Number T21AA T/zAJSparz7 TA)G 8. gnated Facility Name and Sit Address U.S. EPA ID Number Y1,Cca eher l L. �4f.4yr t:6Sf Amb i 01 Vtilegtiti Eta. 1�'t5 i�el\ vevl }vii ►A -1-nts4 RIS Facilitys Phone: 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11, Total 12. Unit 13. Waste Codes HM and Packing Group (9 any)) No. Type Quantity Wtivol. �,nn )3141 N -P D L I P6 I 4Uffi �d W f 3 'UV All I out_ ,.. 4. .. 1 Special Handling InsfiructlansandAddifional Informs - --' I- 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are linty and accurately described above by the prope issing name, and are classified, packaged, markad and labe6;dlplacarded, and are in all respects in proper condition for transportaccording to applicalje international and national governmental regulations. If expos shipment and I am the Primary Expdi_ I certify, that the contents of this consignment conform to the terms of the attachedEPAAcknovdi4rent of consent. I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am Marge. quantity generator) or (b) (if I am a small quantity generator) is We. e orator s PrmlediTyped NameIJA .gra re Month Day Year 4kyr-1VITlyn, 1817 ka I// —11 F InlegiatonalShipments El Import to U.S. El apart frau U.S. Port of entry/exit: Transponer signature for exports only): Dale leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials ` Transporter 1:PnntedlTypso Name Month Day year 1Oii�&_11grri `� N I ! I �. Transporter 2 PrImedflyped Nae Signature F Month Day Year 18 Discrepancy - - 189. Discrepancy Indication SpaceQuantil ❑ y 1-1 Type ❑ ResMue ❑ Partial Rejection ❑ Ful Rejection Manifest Reference Number: 1Bb. Alternate Facility (a Generates) U.S. EPA ID Number J V LL Facili .s Phone: w 18c. Signature ofAltemale Facility(or Generator) Month Day Year Q 2 19, Hazardous Waste Report Management Method Codes (t.e.,-codes for hazardous waste healment, disposal, and recydjng systems) 4. 20. Deslynated Facility Ownef or Operalo - CeNfication of receipt of hazardous materials covered by the manilest,except as noted in Item 18a PrinleNTyped Name Signald(e Monty Day Year EPA Form 8700-22 (Rev. 3-05) PfeftMs editions; are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF,REQUIREO)