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Please print or type.(Form designed for use on elite(12-pitch),typewritec) Form Approved.OMB No.2050-0039 <br /> UNIFORMHAZARDOUS 1.Generator ID Number rte. 2.P gel of 3.Emergency Response Phone 4.Manifest Tracking Number - <br /> ASTEMANIFEST C•"f='''�� (� � '413-EOEA.t Q1 43X237 JJK <br /> eneratara Name and Mallin Address TT.� Generators Site Address tiligerent than mailing address) <br /> !'/^:ail�li' #QI.rlll il.Y- T.JEr{fTIU�.1I(1I!I <br /> ,C;7'i 8."Atd'.ii.lif 11J. <br /> s FEB 2 4 2015 <br /> Generators Phonei 'n'`- '"'h=`� <br /> 6.Transporter l Company Name - U.S.EPAIDNumber <br /> ea pa'PA,1atg.lns. ENVIRONMENTAL :;•.F•_;cziurtr' <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designaled:Fedidy q";IQ.d g teAddrem U.S.EPA ID Number <br /> v''. 6S.,r23_ <br /> Fadliys Phone: 1:�,it, •Grp <br /> 9a. 9b.U.S.OOT Description(including ProperShipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> NM and Packing Group(if any)) No. Type Quantity WtNol. <br /> i t .r? : t�. �fF° f11•.tolivlr.NL.`:l.'r<:rJiO:y�;61:0@ :it26Ei O7't;�3 3 t`(:; -' "�.(/i z.^�{^'• r. i KI1 .2 i:3 <br /> O r J <br /> w <br /> z 2. <br /> 3. <br /> 4. <br /> pe,a Har)d�ing Instructions and Additional Information drJaKc-• ;'G Gi <br /> 1Y"�Ptt�r 6 r i•.t� !1R'F: ilIEuC'1.f-iPl. 1J=E QS;li.-: •1rprwO l ure'letre`,]:iU4C-5 I <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fullyand accurately described above by the propershipping name,aid are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in propercundition forlrensport according to applicable intemationaland national govemmental regula86ns,.If export shipment and l moths Primary <br /> Exporter,I certify that the contents of this consignment conform to the lens of the attached EPAAcknowledgment of Consent. <br /> - ----.Icertify thabthe waste minimization statement Identified in 40 CFR 262.27(a)(if lam a large quanfity generator)or(b)(if I am a small quantity generator)is We:-- ------ ------ -- -- <br /> Generetorsl0gerors Pdntedlfyped Name- Signature <br /> Me ith ,Day Year <br /> 16.International Shipments <br /> r- -'- � ❑Import to U.S. El Export from U.S. Pod ofentrylexiC <br /> K Transporter signature(for exports only): - Dale leaving U.S.: <br /> w <br /> V.Transpoder-Acknowledgment of Receipt ofMatedals <br /> Transports dnl dRyped me f Signature (' /i ` Month Day. year. <br /> O 1)t i� ;:.?ice i`% . <br /> a r, 7A <br /> N <br /> Z <br /> Transpoder2 PrintedRyped Name Signature 1.' Month Day Year <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Residue <br /> ❑Type El Partial Rejection 'El Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) _ U.S.EPA ID Number <br /> zi <br /> U <br /> LL Faciliys Phone: " - - - f - <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 2 ardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> n <br /> i. 2. 3. 4. <br /> . . <br /> 20.Designatedd Facility Owner or Operator:Codification of receipt of hazardous materials covered by the manifest except as nded in Item its <br /> Pdnledfryped Name Signature Month Day Year <br /> P k Form 8700-22(Rev.3-05) Previous editions are obsolete. =ter=�•+��� •• <br />