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m V- EPA printtype. (Form . Signe for use on elite (12 -pi cl,, ., ewdter.) Form Approved. OMB No. 2050-0039 kop,,n H RDOUS 1. a to 0 N r - �)I .Page 1 of 3. Emergency Res erse Phone 4. Manifest Tracking Number 000894538 FLE MANIFEST rs Na and Mading Address Generator's SiteAddress (ridifferent than mailing add ss) U10 CO �501'd Lkb5tC bivium AM hiait AfZeu;6-p/y�L 1 �p man .�co�quln �C rlouScH�til W0.5Fe. n C A• Q 5� -1 F `.xo 5. F2.A� �rt�� Fo�.D Si' St oe s oxo Gene YRbn€"tG I � y 6.T oder 1 Company Name U.S. EPA ID umber ' 1 CIXM Foo,ronmPrilalr1J1 t1 T. Transporter 2 Company Name �`� U.��P61p.{J}rgi�„✓-.g�„ 5e-7 E 7d!`i i c J B. Designated Facility Name and Site Address U.S. EPA ID Number Uean Nar� OrS knvlron>~,e,i}c�l 5erv.rLeb (Nivi1�11FaCl�t+� X 1 li 30LA+ h (4w�f)-`1l _ _ Facility's Phone: ) I y- `-�iaot ga HM 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, and Packing Group (if any)) 10. Containers 11. Total Quantity 12, Unit Wt.Nol. 13. Waste Codes No. Type FlamiIniLA4dbon.o.s-)5i'hlnneF, - �G iojeum r afllalasCl-mw J,3,un194�, �n1 LH t-) I� 10Q z 2. Erni'reloedtv}a�er;0.1,C ;nFThlrfrer,v;1 5� 1 6. Int- rela-Erri r�1a+PFmCiI�!'U�n�'�'1tnnEi©1 � idr &�5R, pair) j'(H11W))3,unI4.(Dib,P6 (I- Mammabte 50►•d.,511ordanfc•, r).o.s`.LCr2tStdL t�%1.1C�lVC5CHr1w),A-1. U1Jl�ja,.'Sim III C C F 1 N '� 14. Special Handling Instructions and Additional Information ►•) L 1� -�©(vat lei x .SDm .)C+i �+C71v 5 �1 — X CF '; �)Cli yo42dto y. �-IoCPi j.- X.L1.�• CF ` r z 3 'x0ubtc. \jl" CA 11.3-15.53—ocS �� C } I , Tia , r T c:' 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and Iabeledlplacarded, 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 that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (N I am a large quantity generator) or (b) (F I am a small gyantity, generator) is true. enerelofs 0 ero s P me /Typed ame mgnatur , s on ay `'ear WJd —r z 16. International Shipments El import to U.S. El Export from U.S. Port of entrylexit: Transporter signature for exports only): Date leaving U.S.: 17, Transporter Acknowledgment of Receipt of Materials Transpc Name ign� Month ay Year ed7Typetl r A � I Ion Q Transporter 2PriNameDoth Day ear } Sign re ,,, �Jl t fG-. - �. ' ✓fx.. 1 12 y I 1 18. Discrepancl I 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Altemate Facility (or Generator) rt U.S. EPA ID Number J V LL Facility's Phone: w 18c. Signature of Alternate Facility(or Generator) Month Day Year Q z a—i 19. Hazardous WWddsm Report Management Method Codes (i.e., coderssffor haz.�aardjous waste treatment, disposal, and recycling systems) f 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdliiydrrypecl Name Sig .11 re Month D y Year P CcxL Ve,IJ_- c�r2� CchIC Q /d P/- ` EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR bin