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. M at_n t-e d 3`)aS/,s- Please pint or type,(Form designed for use on elite(12-pitch)typewriter.) ,A 1,Generator 10 Number Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 2.Page 1 of 3.E nergancy Response Phone 4.Manifest Tracking Number SKS WASTE MANIFEST ¢ ) a- 7 , 13 V(�V t� - S.Genera 75 Name and Main Address -` ' ., Genofaier'a Site Addresa!d different than maikng address) Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number R De,gneled Fatuity Name and Site Address U.S.EPA 10 Number FacllsPhone ge lib.U.S.DOT De-w' ;including Pnrper Shipping Name,Hazard C!Ms.ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit 1. No Type Quantity M,Ne,,. 13 Waste Godes O W z 2 ECEIVED-ff MAR 2 7 2015 4. HUNMENi TAL )�CQ iTIU f'1�DppT1ACAIT 14.Special Handling 7—lostointior, and Additional information 15 GENERATOR'StOFFEROR'S CERTIFICATION:I hereby dec,,re that the contents of this consignment are fully and accurately desrnbed above by the proper shipping name,and are classified,packaged, marked and Iabeledrplacanted,and are it all respects in proper conoiMi n for transport according to a*.irA Ne international and national govenlmentai regulations.If export shipment and I am the Primary Exporter I comity that the contents of this consfgnmenl conform to the terms of the attached EPA Acknowleegment of Consent I certify Burt the w sta minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a sinal quantity generator)is true Gererato,FJO%rors Pontetl•Tytied Nama Signature Month pay Year ,i f6.InternationalshipmenIs 1, D I:n{xr to U.S ❑Export from U.S. Porf of entry/exit Transpuner signature(for extorts only): - Datoleaving U.S.: 17.Trans(xnrarAcknowkdgroml of Recelpt rr Materials CY Transporter 1 13rinlert7Typod Name O Sgnatu,? Month Day Year Transportar 2 Pdnled/Typerf Name Sgnature Month Day Year 18 Dscreparcy 16a.Discrepancy Indication Space ..... �� Ouam rr ❑Type ❑Residue I_i Partial Rejection ❑Full Rqw-tion 186.Alinr.,atm Pwisty to C,anararorl Manifest Reference Number. _ U.S.EPA i0 Numuer J V W Facility's Phone: w 1 c.,ignature of Alternate Facility(at Generators Month Day Year W19 Hazardm!s Waste Report Management Method Codes(i.e.,codes for hazardous Haste treatment,disposal,and recycling systems) 11 t 2. 3, 4. 20.Designated Fac lily Owner or Operalor:Cer6tic )on of remiot of hazardous mater is a vered by the marnfest axcepl as Holed n Item 18a PdnteofTypu�l Plane Signature month Day Year EPA Form 8700-22(Rey 3-05) Previous editions are obsolete. I GENERATOR'S INITIAL.COPY