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i` S 41 &" <br />�. <br />I p R a:,Kase print or pe. (Form designed for use on elite (12 -pit <br />11 <br />a�r��rbl/ <br />rewriter.) - !" 1 (7 Form Approved. OMB No. 2050-0039 <br />61 <br />UNIFORM HAZARDOUS 11, Ge for ID Number <br />N I j W 1 J4 <br />2. Pa e 1 of <br />3. Emergency Response Phc <br />y % Qj <br />4. Manifest Tracking Number <br />000 <br />00 594517 F L E <br />WASTE MANIFEST - �—! <br />0 t/�J <br />:5.Tor's No and m Address Gen to SrteA dress d igerenttha marlin address <br />>7 3 �t 1 C Sof (c� l-lYzSte l rV,s )ut1 int y ,Iri�a4o Xr'i0 LLb <br />, WX I I '- nJ�(gij) 0 H I LLbl �e �cccfit}y <br />I <br />� <br />yn a 1 {� ��/ <br />{Q] "�ol / K_� f�l�� St <br />&V �a- �YfV <br />Generetofs �^ ..A.d(Jt0 <br />6. T syrpo er 1 Company Name <br />G deal <br />. <br />U.S. EPA ID Number <br />0 <br />l V\a(bof5 <br />nn <br />In aaaSU <br />7. Transporter 2 Company Name 'U.S. EPA ID Number <br />g.D ignate li 11me an to as G1 I Q.{.� Rai, ('s, Lnuie(in 11'e(l�f c,,e," AC45 �. ,S. EPA ID Number <br />T1(''!/1 UU <br />w -11 <br />` ( p 1 <br />'s K I I N 9 ly,5 Bob Com-;,... � kc � � 7� I <br />Facilit Phone: 1+11 FJf.i t o aZ.ok' Q ✓ <br />ga <br />HM <br />go. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />10..Containers <br />11. Total "" <br />puantiry <br />12. Unit <br />WiNal. <br />13. Waste Codes <br />No, <br />Type <br />sla bl N PI rn.o.�.,(Tbnin[t,z,),? (d <br />► FGA <br />�Ut�l <br />Q14A <br />�te VCA <br />_ r <br />v3lao <br />N <br />` } <br />� KA �I i rl•Gi�C`r lGlf f <br />11baalr1� (�l{W) 3Ufll (v3 RGI <br />4 <br />Girl} I? �P i"[�f tla. C Il1� YftlntlE('., <br />u <br />Ort PAI�i[�tnw) unlALP61P�II <br />m <br />(pipl <br />1 hwj <br />v <br />I C14 <br />1 LFW <br />al Information <br />14. Wacial Handling Instructions and Aoi' ion <br />15:5 n-1 -)L7143y�a5r u0)5 0, qW x <br />I r1a c��a1 .�c <br />—r +�,.Eso)zr "3 <br />N <br />15. GENERATOR'S/OFFEROR'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, <br />marked and labeled/placarded, and are In all respects in proper condition for transport according to applicable international and national governmental regulators. If export shipment and I am the Primary <br />Exporter, I cattily that the contents of this consignment conform to the tenns of the attached EPAAcknoWedgment of Consent. <br />I certify that the waste.minimiza6on statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />t <br />Generslo slOfferars Pdnte yped NameIgna a on ay Year <br />rn rt1 t E LcJ I c. t �.1 <br />J <br />16. International Shipments <br />❑ Import to U.S. ❑ Expad from U.S. Part of entrylexit: <br />Transporter signature for exports only): Date leaving U.S.: <br />w <br />17. TransporterAcknowtiedgment of Receipt of Materials <br />a <br />Transporter 1 Printed/TL�'pPed Name / Signature MonthDay Year <br />%�! fCCi -RI C � % % j <br />0 I <br />-e -(i G3i�1 A.) cert GV.. <br />Z <br />Trensp 2 Printed/Typed Name Signatur€t ort Day ear <br />18. Discrepancy <br />r <br />18a. Discrepancy Indication Space ❑ Ouanfiry 1:1 Type ❑Residue❑ PaNal Rejaction El Fall Rejection <br />Manifest Reference Number: <br />16b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />U <br />Q <br />ri <br />Facili s Phone: <br />W <br />18c. Signature ofAltemate Facility (or Generator) Month Day Year <br />Q <br />2 <br />N19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hammous waste treatment, disposal, and recycling systems) <br />20. Design ted Facllily tromer or Operator, Certification of receipt of hazardous materials coverecykthe m ifest except as noted in Item 18a <br />ted/Typed Uame / ature Md �9ay Year <br />EPA <br />Form 8700-22 (Rev. 3-05) Previous editions are obsolete. nFRIeMATF11 FArn ITY Tf) GFNFRAI <br />61 <br />