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Piease prin:or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS '.$eneralor ID Numoer b 75 2.nage 1 or 3 Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST !d St .�-n-15-1109 012329001 F L E <br /> enerator's Name and Maling Address Gunarato's Sit.Address!if dfierent C n maili-y;deressi <br /> ptpPAT« Sk�IPPtw-, 4--rRZ�k-!N4 �o <br /> 1151" 7 c?AlIz*tS /5RACg Rev* Z4D1 C4, `N' <br /> Generator's?none: 2'M 4&(4- <br /> 6.Transporter 1 Company Name U S EPA ID Number <br /> ftbV AcN c,9Get /L S e f btiC, r C*Qono o 0 <br /> 7.Transporter 2 Company Name I U S.EPA ID Number <br /> 8.Designated Facility Name and Site Address Mill <br /> � I'WO�J, * 0111- <br /> �n a w.5��� L� U.S EPA ID Number <br /> ti�Jo L�Av� l� IK`'v � <br /> �i� /Vg 0 /wopopsro C,4-. X535? <br /> Facl ly's Pnone: .. V Sj• 1�1 �k�0 <br /> 00 110 1 <br /> 9a. 9b.U.S.DOT Description(including Proper SNpp,rtg Name,Hazard Class,10 Number, t0.Containers 11 Total 12.Unit <br /> HM and Packing Group(I any)) 13.Waste Codes <br /> No Type Quantity WI.VoI <br /> o ' NaN- /Ze4ft d-1j*-4hx Pv uS <br /> LU <br /> Cvl'C IA)Aral2 ) <br /> W <br /> Z <br /> w <br /> "F <br /> 14.Special Handing instructions and Addilioral(nformavion <br /> �L Ir <br /> oyoy/y—� fc.�Y— <br /> Ib. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are ful'y and accurately describes above by he proper sn-pping name,and are cassifed,packaged, <br /> marked and lai7 a'placardec,and are in all respects.n proper condition for transpor,according to applicable inlernatwnaland natcna,governments regulations-If export shipment and I am the Primary <br /> convents Exporter,I certify that the cents of his consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(it I am a small quantty generator)s true. <br /> Generators+ Ferces Printed.Ty000e ,,,Vame ` Signature <br /> R �; n�J Month Day Year <br /> 16,International Shipments <br /> f ❑Import to if S LJ Export from J S. Por,w entry/exit _ <br /> ? Transporter signature(,for exports only); Cate leaving L.S.: <br /> LU <br /> 17 Transporter Andkrlowledgn-ent of Receipt of t laterials <br /> Transporter t Pnmed/Typed Name Signature Month Day Year } <br /> Lto <br /> Z Transporter 2 Printed/Typed Name <br /> Q Signature klonr. 0ay ear <br /> 18 D,screpancy <br /> 18a.Discrepancy Indication Space L Quantity Type yp n Residue <br /> ❑ �I Partial Rejection ❑Fult Rejection <br /> Manifest Refe encs Number: <br /> 18t.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> u- Faphty's Phone: <br /> Lo 18c.Signature o(Altemate Facility(or Generator) Mont.? Day Year <br /> a <br /> Z <br /> F019.Hazardous Waste Repoq Management Method Coces,.e.,codes for hazardous waste treatment.disposal,and recycling systems) <br /> w , <br /> O / / 2. 3. 4 <br /> 2V.Designatuli act dy Owner or Operator:Certification of reSpyt of hazardou lnalerials covered by the manifest except as flaed it Item:8a <br /> Primed?ypec Name Signature Month Day Year <br /> EPA Form 8700.22(Rq(12-17) Previous editions are obsolete. <br />