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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS ID Page 1 of 4.Manifest Tracking Number <br /> WASTE MANIFEST C,A ILI[015�72 0 0 6 85:45 9!9 F L E <br /> 577nerato7s Name and Mailing Address Generatior's,Site Address(if different than mailing address) <br /> Generators <br /> Transporter I Company Name U.S.EPA ID Number <br /> "&*-ft C At.',Kf C*_1 8 M <br /> K�Ak VALL.VT WMiV OR-M. <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Addre'N&A,( YK)Wri,iX*A,I U.S.EPA 10 Number <br /> t 185-5 WtijTE Rs.�(:K R& <br /> RA�+.'J, CKIR 00VA,r,"A. 'KW 4 <br /> LA-I Q-J'-h I mel <br /> Facilil's Phone: <br /> 9a. 9b.U.S.DOT Description(mcluding Proper Shipping Name,Hazard Class,!D Number, 1D.Containers 11.Total 12.Unit 13.Waste Codes <br /> FIM and Packing Group(if any)) No. Type Quantity W11vol. <br /> —1.Mfivimum.sovi'mums m's I r' I <br /> cc >"J"4 <br /> 170 <br /> 2. <br /> 0 ------- <br /> 3. <br /> 4. U 0 312013: 1 <br /> E YJ VWJ <br /> VIVIL-11V <br /> 14.Special Handling Instructions and Additional Information HF:-AI E RTMENIT <br /> r4to�',Lk 's�*ufjs&CAL-i3i"'L f:ME-',1G C�AVACJI.. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to tha terms of the attached EPAAcknoWedgment of C?nsent. <br /> I certify that he waste minimization statement Identified In 40 CFR 26Z27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators/Offeroes Pn-n-t;@Ty—ped Name signature on Day Yca r <br /> a 16.International ShipmentsEl Import to U.S. F-]Export from U.S. Pod of entrylexit: <br /> Transporter sLtature ifor exports only): Date leaving U.S: <br /> UW 17.Transport terAclutowledgment of Receipt of Materials <br /> 1j.Transporter 1 Print6drTyped Name Signature Month Day Y <br /> ear <br /> 0 <br /> Transporter 2 PrintedfTyped Name Signature on Uay Year <br /> L <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space F� Quantity 10 Type EJ Residue ❑Partial Rejection ❑Full Rejecocia <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Facility's Phone: <br /> uj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste tres!ment,disposal,and recycling systems) <br /> 1. <br /> ras <br /> _12 <br /> 20.Designated Faclilty,0wrer or Operator.Cedification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedl-typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete, TRANVORTER'S COPY <br /> ................................. <br />