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Please print or type.(Farm designed far lase an elire(12-pitch)typewriter) Farm Approved.OMB No.2050-0039 <br /> -T- 1. iQ [7_Page 1 of 3 ency Phope 0.Pdanifest Trading Number <br /> UNCFORM N OUS •k —,—�•� <br /> WASTE � 2 JJKi <br /> :G emws and M" Add Ga Sr A less{d 8 enittsaus ) <br /> 85.,.,,°- .s i�sk'•. *¢7� : yr rr'S e't C ',j^�� <br /> C-enetatces Phone: "-i 7545 <br /> U.S.EPA IDNumber <br /> 6 T iter i Company Name <br /> ..z.a;k s:�. =:;r €';''aixu;:�;1x•�a .. c:.K. ...�,.�e,.° <br /> 7.Transporter z Company Name <br /> U.S.EPA ID Number <br /> 8.Designated Facility Nara and She rem U.S.EPA ID Number <br /> Facility's Phone: -'f •R, E7 <br /> ge 9b.U.S.DOT Description(including Proper Shipping Name,HEUMd O&M,iD NUMbOr, 10.Containers 11.Total 12 Urd 13.Waste Codes <br /> I and PacfdW Graaf(If any)) No. Type Quardy WLVol. <br /> 1- $t2aIE'R d i xe: Ltyl s�W-as m'sulk r"tfy v?k j; .i'iwi <br /> O <br /> r,.. <br /> i` <br /> Uj <br /> 3. <br /> 4. <br /> e 4.5 "I Riang,lmdructions and Mlitional I*rmah <br /> r. <br /> 15. GENERATOWSIOFFEROMS CATION:I heivloy declare that the cwWrts of this consignment are fuer and aoarcaely described above by the proper shipping name,and are dassifiect,packaged, <br /> marked and labeta#13carded,and are In d respeots in proper condition for Mnspon axOVto appkabig mternational and national govemmental reguistions.I wqxrt shipment and I arts the <br /> Exporter,i cartily that the contents of this consignmem conform to the terms of the attached ERkAdawrAedgmentofConsent. <br /> I ditty that the waste mi• ` don statement Warded In 40 CFR 262274a)Cd I am a Lvge quantity generator)or(b)(ifl am a sma6 ,2tor)is true. <br /> Year <br /> Generates`, p rats Pcinted/f Stg /' <br /> MonthDay <br /> °`P$t4'� =r°,"'� .O°'�:r�r*' =` �..•"i €fie '�? .� <br /> 16:Internarmnai Shoralts <br /> ❑ th E1.S. ❑ faunae U.S:fj PdrYoFeitfryte ` <br /> Transporter sigoat are(tor only): Date leaving U.S.: <br /> W 17.T anti of of <br /> WTr]t P' Name /', <br /> Signature Month Day Year <br /> {* . <br /> 2 Tres r-R; n yped Name �. `i: ' �p <br /> iYIS <br /> ' Day Year <br /> ' k <br /> 7&Discrepancy <br /> 18a.Discrepancy indication Space ❑Quantity ❑ ❑Residue ❑Partial Rejecter ❑Frdl Rapolion" <br /> ManifestReferenoeNumber <br /> F i8b.Alternate Facility(or Generator) US.EPA ID Nunber <br /> v <br /> Fara s e <br /> 1$c Signature of to Facility(or Gore-") <br /> Day Year <br /> a - . <br /> g jg. _._.. .Ftepqrt Management MOMW Cates{i.e. waste ,and sy i.) <br /> 2O.Designated Facility OwworOperstor Certification ofteceiptafhazardousmateflats cowed bythentanifestexceptas noted in iters 18a <br /> tmntfa <br /> Day Year <br /> des' f , <br /> AW <br /> EPA Form 8700-22(Rev.M5) Previous editions are obsolete. bESIGPIATED FAcury TO oENERAToR <br />