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Please print or type.(Form designed for use on elite(1&pitch)typewriter) 20 c(HII� Fgon Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number G>400ooq p (Q59 2.Page i of 3.Emergency Response Phone 4.Nandest01"M38 <br /> cki Number <br /> um er 3 8 JJ K <br /> WASTE MANIFEST `t I 0E Sts y�r '01 I{ (lUn1�(l�j <br /> 5.Generames Name and Mailing ass Goamtofs SilwA.dod (8 dii ent than mailing addressi <br /> l3`J� rS�C�J t; '4 'Z fJ� r�OopxA Y_Lahl� <br /> M141012prulcpoe o��'t Steck "O r a .95205 <br /> Gerreretq's Puma: co ''i' 5Z3 <br /> 6.Transporter f Company Name U.S.EPA ID Number <br /> MOt2C Li Ewd;000 - _Al &wit cc-,i 'r�►c CA � � 4243 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> I\ t t r\k4. r rak i C,4 1 eC la' C. (!4 (•r no r to <br /> ' ted <br /> B. 56kiy Name and She Address yy U.S.EPA ID Number <br /> I(010W -ft IIfTN51 <br /> Fadi s Phone: Soo - 0 7+ - -1 Z V f a/ N( I <br /> ge. 9b.U.S.DOT Description Ondudmg Pmper SNppmg Name,Hazard Class,ID Number, t0.Container 11.Total 12.Unit 13.Waste Codes <br /> HM and Fading Group Of any)) No. Type Quantity wuvol. <br /> X Tw) l5 O)LLl!?S COQ a 1 vi7�k10. S CJI OF S <br /> uu�� Jl Nc <br /> us 2. <br /> r� <br /> ASTE WAS RECENm, <br /> 3. rXmas .TRpa7a¢M OR RE'SE CROSBY NDIN AHD Po SVeSFTfUpyy <br /> :INKS ENvulo,TO THEN,BY i1R OVF]iTON,IN OPFlt.1 AE <br /> •mlH TIg FNVBtONMFMAL DF➢ART Hr OF TOXI SUMAN THE JIy UNi.0 <br /> ,11E RESOUR �OrECf1ON A CY CONIkOL <br /> AHD 'SPATE REOUI,eTOHS. CItOT Y ACr OF I 6 T %tOvts HS W <br /> 4' ,F]tAVrl TO ACffyr t OvpITOALL wnw AtlIF <br /> 'rCORDPIQY T� NCID <br /> WAS AND ALL WASTE HAS B4prr�/ '.'s <br /> 14.Sperm Handling Instructions;and AddFtlonal Infomuation <br /> 15. GENERATOR'S'OFFEROR'S CERTIFICATION:I hereby declare Ilial the contents of this consignment are fully and accuratety,described above by the proper ahgping name and are dassihei,packaged, <br /> marked and Iabelecilplacarded,anti are in all respects in proper condition for transport according to applicable international and national governmental regulations.I export shipment and I am the Primary <br /> Exporter,I candy,that the contents of this consignment conform b the Im"of fire attached EPAAdeowledgme0t M Consent. <br /> I cerUy: &t IbB waste minimlratin statement identified in 40 CFR 26Z.27(a)(II am a law quantity or(b)(til am a small quan8tygererator)is true. _ <br /> GenerataY hPrinted1(y�d <br /> Is me 5 naNre Month Day Year <br /> rte✓ I ,i jo 1`7 <br /> _+ i6.Intemagonal Shipments ❑Import to U.S. <br /> ❑Export flan U.S. Pod of enhylexil: <br /> Transporter signature(fa exports only,): Date leafing U.S.: <br /> W 17.TrerepodaAcknvMedgment ofRwept of Materials <br /> OTransporierl t�DNryped Name Month Day Year <br /> Nj;�' l i <br /> = Day Year <br /> ran` er 2 Pdn yped Nemo 3ignadae __ Y <br /> a y 1. l-lam- I'S - <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Qu artily ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(a Generator) U.S.EPA ID Number <br /> V <br /> mai Facility's Phone: <br /> 18c.Signature of Alternate Facdiy,(or Generator) Monts Day Year <br /> a <br /> Z <br /> h19.Hazardous W <br /> \ast <br /> 'eR1SeportManagement Method Codas(i.e.,arias for hazardous waste treatment,disposal,and recycling systems) <br /> O 1 1 11 h{I 2 3. 4. <br /> L <br /> 1 <br /> 20.Designated Facility Ovmer or Operate.Comficatron of receipt of hazardous matenals covered by me mangest except as nd6din Item laa !' <br /> POntedrTyped SI Is i Month Day Yparl <br /> EPA Form 8700.22(Rev.3-05) Previou editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />