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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 1.Generator ID Number 2.Page 1 of 3.Em;qency Response Phone 4.Manifest Trackin Number UNIFORM HAZARDOUSr� f csp tM. WASTE MANIFEST CAI g( aa ' r �! ttpp``g}Y np , � r, ' //a ;,xei.P�? a.r /'V, ,!1p4.fk�.,l .2. n ..N's1C"J.,� i..5:i 'tin .)., .. .i�•x.. h #><r JJ K 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) mc.. IN -ID 1•9�TX) ''��AIAE:' 7-TACT, '.f•��f?i ACTr A,A 915.176 651t Generator's Phone: VJ 05 S'0 id-;+'V:. �' i °'R'r f'""''da 'y aµ:IT cm 9I.: m 8.Transporter 1 Company Name U.S.EPA ID Number 5vic. -eY151)00 2®94.'i.�. 7.Transporter Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Y00 )S AMEMA V'`.BEi3T eye r r 6•.y Facility's Phone: 310 Si ill-"I?J 00 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1. W Ed9.1f-8t:µlf� Ittr kt8lrg&0fv Lir�I+TY, ��f,,>a3p3i� ;'gym k`:li fir..'f`§d ''>'?21.��: 3Hlr>>tr3S;:1f.�Y.tOd�S;1 d. "m .. � ai 4.t, Z 2. LU 3. 4. 14.Special Handling Instructions and Additional Information 411K.1111 K;ff CI'NT%Ikk.:'I' #5 TRIPPl►]<V QWEX B09 :€.28 Vf °afy ef31i: rws 9ivRiA dp .?93f'"kf €€I��? ��£3 l�'?C1Ft7e S3$l - tihTAY3{ Te'E >?e' gl' bk'2Y°b ;i ?rfl3a$" 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, 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 Exporter,I certify[hat the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a.small quantity generator)is true. Generator'slOfferor's Printed/Typed Name Signature Month Day Year 'CcGi G 1z.� -r 16,International Shipments p t- ❑import to U.S, l ��(� ❑Expo t from U.S. Port ofentry/exit: z Transporter signature(for exports only): Dale leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedliyped Name Slgnaturei Month Day Year ZZ Transporter 2 Printed/Typed Nam6 Sigriature Month Day Year t- 18.Discrepancy 18a.Discrepancy indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 1Bb.Alternate Facility(or Generator) U.S.EPA ID Number J U LL. Facility's Phone: w 18c.Signature of Alternale Facility(or Generator) Month Day Year Q Z F) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed ame Signature Month Day Year cro 11 ; EPA Form 8700-22 1Rhv.3-05) Previous editions are obsolete. �., GENERATOR'S INITIAL COPY