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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />0 <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />I' Generator ID Number <br />NIFORM HAZARDOUS <br />UW 1%AL0001944 i 1 <br />2. Page 1 of <br />3 <br />3. Emenq Res Phone <br />{33<lOj 4.<14 ti00 <br />4. Manifest Tracking Number <br />STEM <br />p?_ 460 JJK <br />1 <br />5. Generator's Name and Mailing Address Generator's Site Address (it different than mailing address) <br />ctNiNJAt VALLEY WASTE SEkYi4ES INC <br />33:19 Ii. TURNER P0 PAf)N91NLY WO <br />PO Kj) 2A 3001 <br />ii <br />�A tJ b! �40 <br />LLOWA <br />OW <br />+1r)ri <br />Generator's Phone. <br />6. Transporter l Company Name U.S.AIDNu <br />A,*31d Y €NYIWtri;tk 04lAt. SEtOWI:S FA Ct e . 9 " 7 7 0 ;+> <br />7. Transporter 2 Curnmy Name U.S. EPA ID Number <br />B. Designated Facility Name and Site Address U.S. EPA ID Number <br />txmiti , itt wI}Cil?N <br />7001! N AtAW.f)A STNFUT <br />:t3PJf6'T4N tJA A t 0 9 0 0 13 3 5 <br />f -410)5W -'/too <br />FaciWs Phone: <br />ga <br />9b. U.S. DOT Deamplion (including Proper Shipping Name, Harard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13, Waste Codes <br />No. <br />Type <br />HM <br />and Packng Group (If any)) <br />Quantity <br />M.Nor. <br />nS. WA5iE PAINT..'. PC- 1f <br />z <br />2 <br />W <br />r7............777 <br />3. <br />4. <br />. Special HaMling Instructions and Additional Information <br />fMf:bH 4NYt_43N1'ALT:Cti4:PAfNEt: 1=cT00-A24-9.�•ti41tAF.itta#4iE:i. i'h1P1)#A1.101.738h,*4 i APPOOPPIIATE <br />P049)NAL PWTECTSYE EUGHNAtENT <br />15. GENERATOR'SIOFFEROR'SCERnFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are dassified, packaged, <br />marked and abeledfplacamed, and are in all respects in proper condition for transport according to applicable international and national gommmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknoMecigment of Consent. <br />I tarty that the waste minimization statement identified in 40 CFR 262.27(a) (i I am a large quantity generator) or (b) (if I am a small quanby, generator) is no. <br />GenerstofslOfferor's Printedflyped Name Signature Month Day Year <br />....____..._._....._�__- <br />y� <br />.� <br />p_ <br />16. International Shipments <br />❑ Impart to US. ❑ Export from U.S. Port olentrylewd: <br />= <br />Transporter signature (for exports only): Date leaving U.S.: <br />w <br />r'7 TransporterAcknowkdgment of Recalls of Materials <br />c <br />M Y <br />Transporter I Pdnted?yped Name Signature •mss .. rr Month Day Year <br />raw '--' <br />a <br />r )t m` i 1 ./r / / - �.. :"->`'`� sr b51 �" -3 <br />Typed <br />Wm <br />Tianspoder 2 Print Nam . Sg"Iture Month Day Year <br />cc <br />K <br />r <br />4, <br />18. DIsc+apancy <br />18a. Discrepancy Indication Space El ❑ Type ❑ ResiOue ❑ Parhal Rejedw ElFullRejection <br />Manifest Reference Number <br />III AI@mate Facility (or Generator) U.S. EPA ID Number <br />J <br />U <br />LL <br />Faciliy's Phone: <br />w <br />Ise. Signature ofARemate Facility (or Generator) <br />Month Day Year <br />Q <br />2 <br />Mg. Hazardous Waste Report Management Method Codes (i.e., codes for haiartlous waste treaMen(tllsposal, and recycling systems) <br />2. <br />3. <br />4. <br />20. Designated Facility Owner or Operator: Cerfificalion of receipt of hazardous materials covered by the manifest except as noted in Item tae <br />PrinleMyPed Name Signature Month Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />