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. . ... ..... ... <br /> V.0.crn iu mmJIura <br /> R ///p °V�r!EsT �^/ovs;,e C4R 000 / 77 sal <br /> 7.Tr Vomer 2 Company Name <br /> U.S.EPA ID Number <br /> B.Designated Facility Name and She Address U.S.EPA ID Number <br /> Z/S ECOLOGY A&V'4b4 > 14C. <br /> /11/Gh4LJ,ny 42S, /a n1/4es sou77/ of C&Eg77y <br /> Facility's Phone: z/-47-`/ , AN eP7W3 rpoo).;39— 'Y943 /v✓7 330 0/0 000 <br /> ga, Be.U.S.DOT Description(Indudirg Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.UnitHM and Packing Group(If 13.Waste Cordes <br /> No. Type Quantity WL/V01. <br /> o '�n/safnl� �U9SrE �c.epas;�E Lrqu/b, Bqs/c, _bcoz � /a3_�/al <br /> 0 X //'/0,QCAn11G, N.0.5. , (5AD1VAy Atvz' 20X/D� -""" - ' <br /> P 7C> d=aG frisk �' 003 7'P 0750 6 <br /> 2'Z!n/33ta•Ip, lila 57;E CioR/ZOS',JE �QVI D, BR sl G, ,DD02 lot3 � 14-/ <br /> X /nfoACA14le- n/.O-s. l`o0yv^y f/1/eRoX/o E), <br /> ,E, r, 4- /,-A oro/ D/= Oaa G 1 <br /> 3,z/A1/7(o0 OORRosiac- /IQU/Z, N•o.s, (FORflic <br /> ), <(Gb), 'e, PC- , ERG #/SAF 00/ TP 0a.'Q5 ------- <br /> 4 7441-7-71 <br /> ----4744179/ 1 �PW, [OR/3F -7V1U770'gs <br /> X PG Z, ER 64 /sS< Oen/ TP 01400 <br /> G — ----- <br /> 14.Special HandlNyI Instructions ad Additional Information <br /> 9B/) 7V yf 070/377/0 -c?393 (3 X ZMES) <br /> g62-) tux' 070/.377/0- 393 (/X ss 4-.41-) <br /> a3) Z✓s /C 070/3/570-//(O/o 1'/X 707.E) <br /> lus 0 043/5 70- //�0 /X x96 /�z- /503- O0a l- j000/ <br /> 15. GENERATOR'SIGFFEROR'S CERTIFICATION: 1 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 IabeleNplacarded,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 certity that the contents of this consignment conform to the terms of the allachad EPAAcknowledgment of Consent <br /> I certly that the waste minimization statement identified in 40 CFR 262.27(x)(h I am a large quantity generator)or O(ifla a smallquanfitygenerator)is true. <br /> GenernfloeslOfferers Pnotedfrype Name Month Day Yea <br /> —s 16.International Shipments <br /> i ❑lmpod he U.S. ❑Egmt her,U.S. Port of entryitudl: <br /> Transporter signature for ex be only): Date laying U.S.: <br /> 04 17.TanspoderAcknowledgment of Receipt of Materials <br /> O Transporter 1 Printed/Typed Name Signature Month Day Year <br /> 6fvnr f� s�loza �-- ash j /5 <br /> G �Transporter 2 PrinteifTyped Name ignawre an ay year <br /> rr <br /> t— <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity E]Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Fadllty(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fad 's Phone: <br /> w IBe.Signature ofAllemate Facility(or Generator) Month Day Year <br /> a <br /> a <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Cedificabon of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintediTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev-3.05) Previous editions are obsolete. I",73i14Np,TEDFFiC:U;'- <br /> REGEIVLL <br /> MAY 13 2015 <br /> ENVIRONMENTAL <br /> UC0'TI-s nCOADTTpCIt" <br />