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Please pr i l or type.(Form designed for use on elite(72-pitch)typewriter Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS tGene'll Number 2Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST c' :; �.Y� 7 <br /> .1av8�s ,., !?a <br /> aS FLE <br /> U <br /> S.Generator's Name and Mailing Adtlress Generatols SlteAddress(ddff" tthanmadingaddmm <br /> svC '607Gy.'i <br /> ,r2 s%S <br /> Carte is Phone: <br /> S.Transporter I Company Name US EPA ID Numbaz <br /> 7 Trersporter 2 Company Name U S.EPA ID Number <br /> 5 i �l y! <br /> 6 Desgnmetl Fan my Name and SRe Address U 5 EPA ID Number Li I <br /> J <br /> 1 }g] zn" i 1 M1 Vii` <br /> Y <br /> Fadli es Phone' <br /> go 96 US DOT Description(indutirg Proper Shipping Name Hazanl Claw]])Number 10.Containers 11 Total 12 Unit <br /> HM and Packing Group(d any)) 13 Waste Codes - <br /> No. Type Quantity VI <br /> or jV <br /> 2 I S� IA <br /> 3 ' <br /> 4 <br /> 14 Stlarial Handling Instntdions aM Additional Information77 �. I :: •. ;a <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents ofMis consignment are fully and 8=;—W descdbed abWe by the gopershippmg name,and are classirwd.padwged <br /> marked and labeled/placarded,and are in all respecis in proper wrinfi "for karsport according to applicable international and.natienal governmental regulations If export shipmentand l am the Primary <br /> Exporter,Icertfy that the contents of this consignment conform to the terns of[he allachad EPAAcknoWedgmentofnt <br /> Iceniy that the waste minimiralion statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or{b) I am a small quantitygeneretor)is We. <br /> Genemor'slOtterare PrIntecil Name oignmure f Month <br /> Day Year <br /> zl <br /> r. <br /> 16 International Shipments <br /> p �^ <br /> F El Import to U S 1:1 Export horn U S Pod of enby/enl. <br /> 2 <br /> — Trans overs'nature for exports onil U.S.: <br /> w 17.TrarspoMrAcknwAedgment of Receipt of Materials <br /> Transporter 1 Printedrryped Name a ignawm Month Dayr <br /> 61 <br /> ac; 2 Pnnted/ryped Name Sgnab;e monin My Year <br /> K <br /> 16.Discrepancy <br /> Ise Discrepancy Indlation Space ❑ amatory ❑Type ❑Residue ❑Partial Rejection ❑Full Reledlan <br /> Merriest f lerenre Number. <br /> 16b Alternate Facility for Generator) US EPA ID Number <br /> J <br /> U <br /> Q <br /> LL <br /> FacilitYs Phone: �(- <br /> W rim Signatureol Ailemale Facliy(or General") Month Day Year <br /> 34111x1 <br /> 50 19.Hazallous Waste Report Management Method Codas Q.e.,codes for hazardous waste treatment,disposal,and re <br /> going systems) <br /> 1 / 2 3 4 <br /> 20.Oesgnated Fe illry Owneror rotor.Car6Aptlon of receipt of hazardous materials covered by the menlfes4axcept as noted in Item les z-- <br /> jll Prin yped N�roe � Sig re Month Oay Year <br /> EPA Form 700-22 ev3.05) Pre4lousedifionsarecbsolete DESIGNATED FACILITI'TOGENERATOR <br />