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Please print or type.(Form designed for use on elite 12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Numb r 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST at ,' JJ K 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) "[2' A Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number ,:,tM N /LAM-DA STREE i Facility's Phone: 01n)51)r-?1 Y) 9a 9b.U.S.DOT Description(including Proper Shil ping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. O z 2. UA c� 3. 4. 14.Special Handling Instructions and Additional Informs on iii `!' 41h!! is 98j `3111 K)iaii;�r�!i �:,' 4i'3'1 11tu;;l:: l i�'t 144.".X l+i' AP!-' >O(4RtTi 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I iereby 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 respe is in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignm nl conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement ident ied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratoeslOfferoes Printed/Typed Name Signature Month Day Year J 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port ofentry/exit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O a z Transporter 2 Printed/Typed Name Signature Month Day Year Q F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z N19.Hazardous Waste Report Management Method Code (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. ° 4. 20.Designated Facility Owner or Operator:Certification o receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdnted/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are o solete. GENERATOR'S INITIAL COPY