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Please print a type.(Forth designed for use on este(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator IO Number 2.Pace 1 of 3.Emergency Response Prone 14.Manifest Tracking Number <br /> WASTE2 7 7 ''--? :--1000038506 DAT <br /> 5.Generat7s Name and Ma'NgAddress Gena"a Ste Address(if awer lhm merry address) <br /> M ilfLiF }m94 uL <br /> E7 41 111V 29tiu JK1 1 Shfi# IM XT <br /> (Y) Genoehmrs Friona o'u-"IMN <br /> 6.Transporter 1 Company Name U3,EPA ID Number <br /> 7.Traruperter2 Company Name LLS EPAIDNu j <br /> d FaritiU' <br /> B.Designated e and S <br /> y Home Address U.S.EPA IDNumber <br /> :"i(sA F_WIMNl EAWL '[2ni, C 31q PSC. E.01 Cr PUTAL c,:MIC''E"a <br /> I i.75E IA s rq':!t Kpi <br /> Frena NAM w11Hi CYR, N 331(2 1313) Iz1-353" <br /> ga gb.U.S.DOTDevi0m(wAKIm Pmw Slipping Nana,Hamad Gass,IDNwdw, 10.Contends 11.TOW 12.Unit 13.Warm Codes <br /> HM andP"CwmplBary)) Mn Type Ouareby Wuva. <br /> t. ult3Z5a 3t5?€ Gu 7il5IYE , :3Tf., InC &Citjg, R..4 ;1(1217 r 37 <br /> o _ 6fti 1iHlliE? Iii—rd ImgfiSNIC RCia anLTS) 'mil d 49 a -- <br /> 2. i«3�77 Rii24;�:'.f: YflST(, 't:Li3, a..9.5, iC�.'+i?a'Tuii, AIs^iEt: 3 .�"rii f{ 'aE91 i <br /> 3. iu ?Z .E A C?t. EF - !`euI"a. R.O. _!lG$E , a-- F .337 13 <br /> ( Lis <br /> 4. <br /> X <br /> 14.Special Harding Instactixs andAdMooal Information J <br /> Sii'v u(ai?IS . 513735-38 E16::7-, z1q.Q nL(.Si M 131 s3 K5-Y'a (R6fi7i F_u,£ kCR <br /> A--, iO PEh3S-1l - E 5(137) RTGPT1C.iiL <br /> 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the comems of this consignment are fully and awrtaletly desorLed above M Ne pmpashipping name,and are classified,packaged, <br /> ma ked and labeled1placarded,and are in al respects in proper condition far transport according to applicable mtemationatand national go mmmenal reguations.If export shipment and I am the Primary <br /> Exporter,I certify that the currants of this consignment conform to the mo>Isof the attached EPAAcAnawledgment of Corson. <br /> I certify first me waste minimization statement identified in 40 CFR 262.27(a)(n l am a large gmntity gaertor)or(b)(II am a small nary genenamr)is the. <br /> Genaraa Oderds Nmedfiliped Name Sigralue O;ir ✓� <br /> Gg, A-l�LJ Much 8' D` <br /> F 16.International Shipments ❑import so U'S ❑Exptxtlrom US. Ponofentrylexit, <br /> Z Transputer signature(for exports only): Data leaving U.S.. <br /> LIS 17.TransporlerAdmwAedgment of Receipt of Materials <br /> OTransporter 1 Pdntecii Name /a ' Su annaDm/ Parr <br /> � <br /> T�. Transporter 2 Pdntedlfyped Name SgnaWfe Mak Day Year <br /> K <br /> r <br /> I <br /> 18.Discrepancy <br /> ills-Discrepancy Indication Space ❑ Duarty 11 Type El Residue ❑Partin Rej�ion Full <br /> Marufart pareunia Nunber Rejection <br /> r 166.Alternate Facility(w Generator) U.S.EPAIDNunber <br /> J <br /> U <br /> LL FsciOtySPhme: <br /> w 18a.S'gnatme of Alternate Facility(or Generator) Nronlh Day Year <br /> zz <br /> N19.1-azardom piste Report Management Method Codes(i.e.,codes for hamdous waste Imalment,disposal,and recydeg syslemS) <br /> 2 f t[q 3 ft q <br /> 28.Designated Facility Owner u0pemtor.Cadifi�nofreceipt ofhaaZaardame materaS coveted by themardfes[/exX"as nUedin lrW 1818�a '�/ ( r <br /> ft" <br /> P YPedt e r Vf., '-^vv lam-ato <br /> Yea <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REOUIRED) <br />