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.J <br />rteasepirrumaype. <br />(roan assigned for Use on elite 02 -pitch' 'writer.) v Form Approved. OMB No. 2050-0039 <br />UNIFORM HAZARDOUS 1. Generator lD Number ' 2 P ge 1 01 3. Emergenq Response Phon 4. Manifest TrackiQngQNumber n R� <br />WASTE MANIFEST /V(',•••J, �) L{OOq�74�jr'02 FLE <br />5. era on N me and Mtail of rA�d ressU AM K I �i�Geyuemtor'g� inte,A�dd�ress (dvl8erent than ailing address) /i � { � � _e �. L _' J � � 1,e,,1 <br />r f CI f1 /Y�}uo) C�(p 1'ip(JCA�v/C /If��l <br />! Aar G wv-ry <br />'!0`g__i�.j <br />p�1�4,•[�, <br />4W+�T <br />�' (�[' l�t.4 <br />y <br />Gen�Fatdi'S P�r�e:T�%ri �)10 ��1... ( lCl..JfJ FiCICIIt <br />CI f iC: �`,t <br />rl Si �JIOC���1� <br />6.T po�er l Company Name <br />U.S. EPA ID Numher <br />�A!r fix 5v . <br />.., .r.. <br />7. TransPorteryQom�any....� U.S.EPA ID Number qq? <br />e.De/si�nateeddd FaRity Rami Ad sass U.S. EPA IDNumber <br />l.'C a lr <br />'} <br />Facility's Phrf :p-ladorAi���i3�cC8 018io3-ir73 CA. 074RICIS <br />ga. <br />HM <br />9b. U.S. DOT Description (including Proper Shipping Name. Hai Class, ID Number, <br />and Packing Group (d any)) <br />10. Containers <br />11. Total <br />12. Unit <br />15. Waste Codes <br />No. <br />Type <br />Quantity <br />Wt.Nd6. <br />Ile <br />I� %�� 1L �.L �t 1 <br />1 r n: y riCL J (%t nT l allllij'Qf Sr lfll . - <br />sEdatn�►`tG <br />ppb <br />C'9S7c� <br />= <br />2. <br />3. <br />4. <br />14. Special Handling Instructions and Additional lnfonnafion <br />t. 'P:G�zy��25 (SxcFj �ic6�`�3.8 <br />15. GENERATOR'SIOPPEROR'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 Iabeledlplacarded, and are in all respects In proper condii for transport according to applicable international and national governmental regulations. If export shipment. and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimisation statement idenfified in 40 CFR 261 cif I em a large quantity generator) or )b) (if I am a small quantity generatorlis We. <br />enemtofsl0lferor's PdnteTTypee ame+ ignaure._, on Day Year <br />Tt t I 1 - -�f' 1) <br />J 16. International Shipments <br />F - ❑Impodto U.S. ❑Export from U.S. Part ofentrylexit <br />Transporter signature for exports onl : Date leavingU.S.: <br />17. Transporter Acknowledgment of Receipt of Materials <br />n <br />TW.ransporter 1 Panted(Typed Name Signature Month gay/ I ear <br />III I�7 io <br />tSignature <br />Transitions— <br />D _ yped� a Mi <br />J� f ay Year <br />-Y.._.. <br />iCM w`lsftc� 6'S 07 <br />1 <br />18x. Disaepancy Indication Space ❑ Quantity ❑Type ❑ Residue ❑ Pallial Rejection ❑ FuY Rejection <br />Manifest Reference Number: - - <br />186. Ali Facility lar Generatop U.S. EPA ID Number <br />J <br />W <br />Fadili s r- one <br />18c. Signa a fAlternate Fadlity (or Generator) Month Day Year <br />4 <br />2 <br />H19. <br />Harardo ste Report arta I'ri2lifMeth'od Godes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />2. 3. <br />4. <br />20. Opgfator GEN�d2tio aiardous alenals cover9d by tha manif ste cept as no ed in I Ba <br />1 <br />Pdnted?yped me t Sign <br />I �, ' r 171)/1767 <br />I.,..It.... <br />EPA <br />Form 8700-22 fI 2-7151 Previn,,a aditiri r. nhenlmn <br />J / Ut5llzil LU FACILITY TO GENERATOR <br />