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Please Print VWe.(Form designed for use on elite(12-pitch(typewriter.) <br /> UNIFORM HAZARDOUS 1.GenemMrlD Number Form Approved.OMB No.2050-0035 <br /> 2.Pegs 1 0l 3.Emeryency Respons�Phone 4.Manliest Tracking Number <br /> MANIFEST 1 - 0 0 7 436218 FL5.Ge—am,$Name and'WngAddress Q reloh sNeAdtlresaaWrg dress) <br /> s ¢rar r cq gsz+S <br /> Gmreralofa <br /> as <br /> .S — "a <br /> r3raporter ompany Name <br /> U.S.EPA ID NTxnber <br /> 7.Transpoder2Canpany Name L D <br /> lL5 EPA ID Number <br /> 0 <br /> 8. esgrutetl ealily Name an Sda Address �Ui'Vr b }s L4 Z.7- <br /> L-4,e— U.S.FPAIDNumber <br /> Faal"Phone:.�'82�'- <br /> 9a. 9b.US.DOT Destlipuon(i,oudmg Proper Shipping Narne,Hazard Cosa,to Number, <br /> HM and Packirg Group(if any)) 10.Containers 11.Totel 12.Ural <br /> No. Type CuanlAy WI.N.I. 13,WesM Codes <br /> be T kJON ter? AFa92 YA4.bt�v; c�3V¢yyZ <br /> L <br /> AAV P-4-10 H-* Y�,a aLLs wr►s7E �i r��> <br /> 3.�ON �c.214 ./ft9z.�R�,t�s �-✓�ISr£.� � <br /> �ozc. coos 3 bF P 3L/ P 3SZ <br /> 4. I <br /> 14.Special Handtltg Inslrutlbns antl Adtlilipnal In yon <br /> ! Y.55c7T) � o lfilC7 <3K tPj �� <br /> l4(0 <br /> 15. GENERATOR'S/DFFERDR'SCERTlF1CATIDN: Ihemyy tledare that ere cmtentsdMs mnegnnenlare Na end adescribed ebovab Me ro <br /> ma 1 and labeled/plaWood.and am M ON mspeds in proper cmdhipm for Vans d acmrtlin m y1111y p �PNrg nenw. Gaesbed.pedaged, <br /> Exporter,I cengy that Me contents of This coregnmant conform to the suras of The attached EPA Aclmouleedgmem f ConsIeMtl national gavemmenWl regulations.It axporl ateprtxrY and I am the Prynary <br /> I cedily Mal Me waste mmimtration statement Wena out in 40 CFR 262.21(a)(it I am a large gUMi gets <br /> -enemto(a arg[s Printed yp�me mlM or(h)(l I em a srna'I quantity gerlarator)IB true. <br /> gna ore <br /> .� Y ext <br /> � 16.Inlmnlatbnal Shipments �� (�. <br /> ❑Import to U.S. ❑Export from U.S. Port of enyylexd <br /> Turns oder 'nature foo onl g <br /> wa- 17.TmnspordrAWrTpwledgmemt of Receipt of Maleda6 oars kaWn u5.. - - _ <br /> K Tra,suono,linledRyp erre <br /> R� Mumh Y Year <br /> Q ranspater 2 PrinleNTypetl Name SS nature ' I( <br /> r on ay Year <br /> i18.Discrepancy <br /> 183.Uaaepancy lndcationrpace ❑ Quantity ❑Type <br /> Residue ❑Partial Rejedan ❑Full Rejection <br /> 18b.AJlamele Fatl6ry(ar Gemeretor) Manifest Relerexe Number. <br /> J ✓�-'-�"' - U.S.EPA IO Number <br /> U <br /> LL Facti sPhone: " <br /> 1Sc.SignaN_;AQ.temam Faafdy(or Gereramr) <br /> Q a or <br /> z v"- <br /> 55 '9.Nazardi Waste Repot Maragemenl WMotl Codes(I.e.,odes for hazeNouswaab treaynenl,dSpmal,a tl recycling systema) <br /> 4 <br /> 1 20.DesgrurM Facility O.wivor OpereKK:GeNNcatun d receipt c Hazardous meledek doomed byMs manifest except as noted in Item 18, <br /> led!fvpe auraENVIMU Signature <br /> A a. <br /> EPA Fun 8700-22(Rev.3-05) Pmviqus etli0ws are obsolete. nEPART <br /> �� DESIGNATED FACILITY TO DESTINATION STATE(IF RI411krt.I <br />