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j •4. 1 <br />Please print or type. (Form designed for use on elite (f2 -bitch) typewriter.) i <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete TRANSPORTER'S COPY <br />UNIFORMtIAZARDOUS <br />1 1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />14. Manifest Tracking Number <br />004533116 <br />JJ K <br />WASTE MANIFESTi <br />i.`d ,-�.u,"C,Pif G i Flf ;; <br />5. Generator's Name and Mailing Address <br />Generator's Site Address (if different than mailing address) <br />PI}CUFLEET, INN - L001 <br />ISs 3 f3. ',; iLaf.F1T(.;J F -a <br />i <br />,;Am ELY.44ONT vvA <br />ELS tiNQ'•r'', (;n, i1SL'+14 <br />Generator's Phone: %%-' 41"R,, <br />6. Transporter 1 Company Name <br />U.S. EPA ID Number <br />FFEh•lU�;' Eht.IFC�ftitlERlir�1_ �Ef+''IG'C ltd;:' t'tk7n ir.x) .5:'i<? <br />;::'.: <br />1: <br />7. Transporter 2 Company Name <br />US EPA ID Number <br />8 Designated Facility Name and Site Address <br />U.S. EPA ID Number <br />Of Ni hiinu!1b Lotd4t3 LLC: <br />i✓"••? �----li... <br />i1$';$ Y411116 �.vi;J' f��i3C <br />Facility's Phone .�16-:314'. <br />9a <br />9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13 Waste Codes <br />No. <br />Type <br />HM <br />and Patting Group (if any)) <br />Quantity <br />Wt.Nol. <br />1 t4i>il-RGF4 Hamdoue Waite Solid i0ty p$00s) <br />O <br />w <br />Z <br />2. <br />W <br />3. <br />4. <br />14 Special Handling Instructions and Additional Information <br />Ft�aJtri ER -. TO HE I F AJE-0 AlgQ Lli�E PT -f: <br />9t, I t frkw, tK C, # 1,' 1 <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 the terms of the attached ET <br />Acknowledgment of Consent. <br />I certify that the waste minimization statemen(idenf fled in 40 CFR 262.27(a) (if I am a large qu <br />lily gen rator) or (b) (if I am a small quantity generator) is !Ne. <br />rator a is 'nledrryped Name <br />S' nature,— <br />Month <br />Day Year <br />F— <br />16. S ipmentsv. <br />Import to U.S. LJ Exp6rt <br />from U.S. Port of entrylexit: - <br />f <br />Z <br />Transporter signature (for exports only): <br />Date Ieaving.0 .: <br />Or <br />17. Transporter Acknowledgment of Receipt of Materials <br />r 1 PhntedfT ame <br />S gnalur4 <br />Month <br />Day Year <br />N <br />Z <br />IjEaaspoker 2 P yped ame <br />ure <br />Day Year <br />Q <br />r <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑- Quantity ❑ Type <br />❑ Residue <br />❑ Partial Rejection ❑ <br />Full Rejection <br />t <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) <br />U.S. EPA ID Number <br />J <br />U <br />Facility's Phone. <br />w <br />1 &. Signature of Altemale Facility (or Generator) <br />Month <br />Day Year <br />Q <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes <br />or hazardous waste treatment, disposal, and recycling systems) <br />� <br />1 <br />2 <br />3 <br />4. <br />` , ,\ <br />\ \ <br />20. Designated Facility Owner or Operator. Cerlificabon of receipt of h <br />ardour materials covered by the manifest except as noted in Item 18a <br />PnnteCyped Name <br />Signature <br />Month <br />Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete TRANSPORTER'S COPY <br />