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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 1.Generator ID Number 2.Page l of 3.Emergency Response Phone /M�anyifest Tncking Number JjK <br /> WASTE MANIFEST ��� 0* � <br /> 5.Generators Name and Mal,5;Ny dress Generators Site Address(ifdifferent than mailing address) <br /> 0 lfGI IT ,DAICTI 1iaTAl[M, rIIf-AI il'=11, n,PV,Ih c'I 'i, UP IAli,AIII 1,9r'i,i; <br /> .INJ(1:1IT( V1H 1i1111AV[ <br /> tAlt JN. !fArtl <br /> GenerelWs Phone: <br /> 6.TA "71 Go�9 I IT11- 1 U.S.] I!., Number <br /> �.. rtl N41 (�I!-IIINIAI `a A.11rY'� I.111i,�,`.... <br /> 7.Transporter 2 Company Name U.S.EPAID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> I+ _ t 1111°11 1411111 r ' ' <br /> 1_Nut h,r bl .tar IAI) 11111, h 11 <br /> IIPq'IyttHNK I <br /> .ii!�ii1L 51 i,t <br /> Fadlil es Phone: <br /> ga 9b.U.S.DOT Desaipion Including Proper Shipping Name,HeadedClass,ID Number, 10.Containers 11.Total 11.Unit 13.Waste Codes <br /> HM and Packing Group(1fari No. Type Quantity WLNoI. <br /> 1 ,I•III ft.VA flAii HPIw+.,I I t'rt r(uitI Wyiftlll <br /> x <br /> 0 <br /> L 2. <br /> 3. <br /> 4. <br /> A4 Sp el Handy��pw In <br /> v1FP1i Pt, ' i' IAIf f1 N`.t 1. .rr IIYI (r:'i if yl <br /> fRF11RtCt I IWN;t Ntf-Ii;tfIYd I '11PI III I 'I <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are rally and accumtelydescribed above by the proper shipping name,and are classified,packaged, <br /> marked and Iabelecifplacarded,and are in ad respects In proper condition(or transport according to applicable International and national governmental regulations.If expod shipment and I am the Primary <br /> Exporter,I cerfN that the contents of this consignment conform to the lama of the attached EPA AcknowledgmenlglconaenL <br /> I certify that the waste minimization statement identified In 40 CFR262.27(a)Or I am a large quantitygenerg[a)or(b)(tlld(n a s)oall candidly pen rotor)is We. j <br /> Ge nI��rralors108eroraprnVTyped Name d; � y Signature .cif �?'�'! aY! y�?] <br /> J 16,Intemallonei Shipments <br /> ❑Import b U.S. ❑Export from U.S. Pod oferdryle>oc <br /> Transporter signature(for"ports only): Date leaving U.S.: <br /> 11:Transporter Acknoxledgmenlof Recelpt of Materials <br /> od Trandsr i Pdntedlfyped Name Signature Month Day Year <br /> npa <br /> i. <br /> z Transporter 2 Pdntedr7yped Name- Signature Monty Dai Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity, ❑Type ❑Residue ❑Partial ReJecson ❑Ful Rejection <br /> Mardfesl Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Faclitys Phone: Month Day Year <br /> w 18c.signature ofAftemate FaclIty(or Generator) <br /> Q <br /> z <br /> N19.Hazardous Waste Repel mens Method Codes Oa.,codes for harardous waste treatment,disposal,and racycttrg systems) <br /> 01. 2• 8 4. <br /> 20.Designated Fedi Owner orOppera .Cerefici of receipt of harardops materials covered by the manifest except as noted in ItemJae <br /> Prim Narta / ,-I �nature � kion Dei Year <br /> i <br /> EPA Form 8700-22(Rev.3'M Previous editions are obsolete. TRANSPORTER'$COPY <br />