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Please peril or type. (Force designed for use on elite (12 -pita,, pewdter.) Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR ll) 'UNIFORM HAZARDOUS i. Generator ID Number 2. Page 1 of I 3. Emergency Response Phone 4. Manifest Tracking Number 000994534 FLE WASTE MANIFEST S. Generator's Name and Mailing Address Generators Site Address(ff different than mailing address) :SPA WRIQUIN Co- ZcOob LkAY D1ulslan A -UM Nm6kA ANhktu-r-..) `5NN J ulu cc) 1w 1sI,)LUQu , Generators Phone: c� - t1 GJcXUI ao 7b,50 S. L (� .r0 .� i` U. Transporter l Company ame 1 IGI c U.S. EPA ID Number rc a 4 f i r 7. Transporter 2 Company Name U.S. EPA IO Num r B. Designated Facility Name and Site Address U.S. EPA ID Number CAecall llarbor;5 E+�UltonmFnE✓ I er�tccs(_I`i()vsl�c,ll�ae��liy� aa,L-Irl` 3u -..Ah NAwk'7 i Facility's Phone: 98 9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, and Packing Group (if any)) 10. Curial ners 11, Total 12. Unit 13. Waste Codes HM No. Type Quantity Wt/V01. (� PI ox1�7, �• U,� i js� 44 �50 AD z W 2. C7 3. i 4. 14. Special Handling Instructions and Additional information C" N dL1 Uc� 34� __(....x m 00—Fqbocx; y ('0 15. GENERATOR'S/OFPEROR'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, 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 Exporter, I certify that the contents of this consignment confomt to the terms of the attached EPA Acknowledgment of Consent. I cedify that the waste minimiration statement identified in 40 CFR 261 (if i am a large quantity generator) or (b) (if I am a small quandty generator) is true. Geneator'slOfferors Pmimcii Name dignature Month U ye ! JA %3- / /ii iEiL &0e'+t1 z 16.International Shipments po Export from U.S. Port of enirylexit: Elim rtto U.S. ❑ Transporter signature for exports only): Date leaving U.S.: w 17. TransporlerAcknowledgment of Receipt of Materials Transporter l PrintedRyped Name Signature .. _.-._,._ _. .,. _.Month ay ear y QTransporter 2 Printed/Typed Name Signature Month Day Year C t— 18. Discrepancy 18z, Discrepancy Indication Space ❑ Quantity ❑ ❑ l ❑Full Rejection ❑Type Resitlue Partial Re'ecSon +yam' / " /YM sypy �wv jA +tee to �•�'NJ Manifest Reference Number: 186. Alternate Facility(or Generator) U.S. EPA ID Number J U Q LL FadiftysPhane: ' 18c.Signalufeef Ajtemzte Facility (or Generator). Manth Day Year Q Z w19. Hammous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 01. 2. - 3. 4. 20. Designated Facility Owner r Operator: Certification of receipt of hazardous materials covered by the anifest except as noted In Item 1 B Pd ed Na re Dpµ� Yeab, 101. Q'I �l kM i11 �/�//J 6 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR ll)