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ry SiJIP# ��1�� -7� 111111111111111111111111111 <br /> Please print or 0 0 6 S Z O a 4 6 S K S <br /> p type.(Form designed for use on elite(i2-pitch)typewriter.) Farm Approved.OMB No.20%0039 <br /> 1.Gene ator ID Number 2.Pa <br /> UNIFORM HAZARDOUS -�_, :.-z ge 1,ef 3.Eme enc Res nse Phon� 4.Manifeat Tracking Number <br /> WASTE MANIFEST F,A� '�137-1 t'`'�i'���-4g8-17I_i_l 006520846 SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(d different than mailing address) <br /> Generator's Phone: ti:0'""464—i 590 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> �H?-€-TY-KLFElJ SYST;.MS INC T'R0171 00l I:-'5 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CI._;=AN HPP' IPS" FNVIRONWNTAi_ SVC INC-. <br /> 8 Designated Facility Name and Site Address U.S EPA ID Number <br /> CLEAN HARBORS EI`.11�If?QIJifEN7�'t! `:if-tiViCi=S, jRS <br /> _c 7 5 HIGHWA`+ 7 <br /> ��'�aa yy-� <br /> t'IMPFLL , pJF F9i�t5 <br /> • 08— "mac-40 t.�� f'i ;?�u i� �,' <br /> Facility's Phone: . <br /> 9a 9b.U.S.DOT Description(including Proper Stopping Name,Hazard Class,ID Number, 10.Conta ners 11.Total 12,Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1. i��t. CN.'., H 7APD[Xi",' W115TE, LIQUID. � Met 0-- ( <br /> � <br /> hJ. . (LFA-D, BFhJ7Ft-JE-, 9, Pr,, �II <br /> w <br /> LU 2. <br /> 0 <br /> 3. <br /> 4. <br /> 14 Special Handling Instructions and Additional Information <br /> T<Z? KP 7b ;6,3511::' PFC:7J I �/ <br /> t)Et7:7 i OU I <br /> �: HR#t7 E�1E�t�EC�JC'� #1-900-468-1-1760 (CH 9K ?"i-I) I <br /> QlIrIA ac 1A <br /> 15. GENERATQR'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 thiscons' nment conform to the terms of the attached EPAACKnowledgment of Consent. <br /> I certify that the waste minimization s Z.Mill <br /> in 40 CFR 2�6/2..27(a)(if I am a large quantity generator)or(b)('dI am a small quantity generator)is true. <br /> CrPrinted Ty Na Si nature Month +'Daffy /Year <br /> ;` / <br /> banal 9hTments <br /> ZImpo to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TransporlerAcknowledgment of Receipt of Materials <br /> Tr rler 1 Print ed Name Signature 9 Month Day Year <br /> y 0. � L�Z )ey <br /> Z r 2 rnted Typed Name Si nature Month Day Year <br /> Q / <br /> � � l <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ElType L-1Resicue ❑Parta'Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Faclllty's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) <br /> � Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1 t 2. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of ous materials covered by the manifest except as noted In Item 18a <br /> PrintenJTyped Name Signature Month- Day, �e <br /> TW11( A if I <br /> f E -�S-J <br /> EA <br /> CEF <br /> EPA Form 8700-22(Rev.3-05) Previous a IIm <br /> tions 41re. oI.te. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> J )80" 26.11540479 <br />