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S Please print or type.(Pon desgled for use an elite Form Approved,OMR No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Grammer 10 Nwtx - <br /> 2.71 d 3.Emergency Response Phone A MaNha Tracking Number <br /> CA H WASTE MANIFEST /] C )oO' • ('+L OpQ,y rJ� 0 FLE <br /> � <br /> S. ra toesNameacn�daMullingq In to SolldwQV c� bpvla c'✓ )� JCAfj JalgU 1() <br /> �4 . Jl�sOx 1 f0 141c <br /> 560 S 1� R �r/l� eFoaCl Si <br /> Gan j� o! 5k 1 b. q <br /> r MPenyR. I U.S.IPAIQ mllr li I ' <br /> jqqj <br /> 7.Transporter 2 Company Name U.S.EPAIDNunlber d,IJ <br /> 8.Designated Fadlty Name and Additions U.S.FPA ID Number <br /> ACQC Com iqC <br /> 3U(07'7 HunT(Axo hot 2 <br /> Fact'' sPw. , 1 AtqLj5qq . 51b yaq- IId�1 R� <br /> ga, 9b.U.S.DOT Descritalidin including;Pmper Shipping Name,Hamm Close,10 Number, 18.Containers; 11.T9MI 12.Unit 18.Waste Codes <br /> HM and Peaking Groups(Kay)) No. Type On" WLNol. <br /> o .q ! ILlehlorina� fph�nLlls yolk , <br /> Una s 71 I Z _ _DSA .!{r0 K , <br /> ,y <br /> W 2 K r e <br /> i F I <br /> 3. <br /> t <br /> 4. <br /> r� I <br /> I <br /> 1.4.Special Handing Instructions and Additional Information �. <br /> LIS * 1-7 <br /> 15. GENERATOR'S/OFFEROR'SCERTIFICA O7�N: ItarebydeplaetlNt from re of l�is'conigrvnent are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and eheled+perarded,and are n all}es{pc{q in pygppFCadM ql for bespoft aecadelg to applicableinternational and national 9D,,Wental regulationsf exportshipment and I am ble Primary <br /> Exporter,I partly that the contents of his copsigrlme dhodforht to the terms of lNea lachad FPAAdmawledgmem of Consent. ` <br /> I certify matthewaeleminkniation stalamenlidentwad in 40CFR26227(a)(llama large quaby genemer)a(b)(Kim aanalt quantitytrue. <br /> nermo ro a m ams gra on ay ear <br /> 1L�✓ Isto e,r A)vNAC-V\2-C _ 7 loci <br /> 18.IdemaaarMl Shymene ❑Import to U.S. erayhdb <br /> ❑&pathan U.3. Paid <br /> Transporter siurs fore only): DOW moving U.S.: <br /> 17.TransporterAtkmaoledgnent of Recept of Materiae <br /> rens 1 Pdn ed N:;If ria m , year <br /> remsporter 2 Pnnwryped Name bignown, ay ear <br /> 18.Discrepancy <br /> 189.Discrepancy Indication Space ❑ OuaNity ❑Type ❑Residue ❑Partial Rejected ❑Full Rejetlion <br /> Manila&Refamnca Number <br /> 18h.Alternate Fadtty,for Generator) U.S.EPA IO Number <br /> H/2 ) <br /> W Fade 's Ptmn9: <br /> y�j 1BG S�aw10 of Ate mate FeCilily(or Generator) Month Day Year <br /> Y <br /> 19.Hamrdous Waste Report Management Method Codes(i.e.,coda for hazardous metals treatment,disputed,and mrytlig systems) <br /> C 1. (/ 2. 3. d. <br /> 141l <br /> 20.Designated Fatty Owner or Operator.Codification ofmotoof hemdbun materiae covered by the manifest except as noted in Item lea <br /> Pn Cr/ Sign Month Day Year <br /> Li ./ ✓ f 0 <br /> EPA Form 8700-22(Rev.30 ) Previtift editions are obsolete. DES FACILITY TO GENERATOR STATE(IF REQUIRED) <br />