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Please pri4xlr type. (Form designed for use on elite (12 -pita, .rplawriter.) <br />Y� <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO -GENERA R <br />UNIFORM HAZARDOUS 1 1. Generator ID Number <br />2. P e 1 dhj 3.,Emgegcy <br />Response Phone <br /><-� <br />4. Manifest Tracking Number <br />000358842 FLE <br />WASTE MANIFEST <br />- <br />5. Generators Name and MallingAddress Gen tors Site Atl fess different than mailing address) <br />Sar) Jimqulrl ��. A+tN �j,ry��(G A111reU13 Sal) Joaqwfi 0o ttcusehDU u3D51c,--k+r,j <br />l�((o" yHaut c1�'r�/ '7660S. A 13rAgvL (urs St. <br />Ur7 '-;IW _ nr 1 .J <br />Gene,5 s'Phone? `-q <br />6. Transporter 1 Company Name U.S. EPA ID Wimber <br />7. Trans �r2 Comp31ka a� � � � U.S. EPA ID Number <br />8. Designated FacilityName and Site Address U.S. EPA ID Number <br />(' 1FQII harbc,(.5 �nt�lfw,nfcnj f `rule <br />•%Uj <br />F&yJ4Qrad0 ML -117-30 (� tj \ U��-• 1 I'73 �' (.< <br />gra <br />HM <br />9b. U.S. DOT Desaiplion (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />10. Containers <br />11. Total <br />Quantity <br />12. Unit <br />WiNol. <br />13. Waste Codes <br />No. <br />Type <br />0 <br />�IQthfliQaJIL: �'�U Q 11•( S,C1�11 ni1Pr5,�e(r✓IC'urlj <br />� <br />-d I1G I4 a 14 Cy 4 a C f+ w 3jUfl l�}93 I PG TL (er3: ld€;j <br />` <br />17� <br />� <br />N . <br />z <br />2.. <br />O� Iii, f ee&Ial1) W Ie-1-41,(PC4 t.-}wtrlra r,011b <br />I <br />3.unl' yob �' = Cilcr-S0-11(oot4 <br />�i F <br />i$95 <br />N <br />PGt,I#- Qer"ca6Fri I"ilcr{rrfc4JCl�I/l{'`1-illant'r,C'tl <br />UU3, <br />! <br />�13G5 <br />xye(�,,r1! NNWj 3�Ufll }jyG <br />I�IY� <br />a. <br />14. Special Handling Instructions and Additional Information <br />I:)CliQ-1010-a1 I�Ax5aIrani �.) CH LI�a5 IL4 xYCF" 3.) �14A CIL 91 S6 M <br />77611 1-& - i* 53 14 8 F c -00 <br />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, <br />marked and Iabeled/placarded, and am in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I cedity'ihat the contents of this consignment conform to the tens of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) IN I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Genmandooes/0 erors Printed ype Name Signature <br />Month Day Year <br />-r <br />16. Intemational Shipments <br />❑ Import to U.S. ❑ Export from U.S. Port of entrylexk: <br />= <br />Transporter signature for exports only): Date leaving U.S.: <br />w <br />17. Transporter Acknowledgment of Receipt of Materials <br />K <br />Transporter 1 Printecirryped Name Signature Month Day Year <br />R <br />N <br />M l R- ~ .1 C*- CQ x--.. ! OJT <br />= <br />r7ff <br />The �{s�p}o/rt�f2 P gted/fyped Na�j igna ure on ay ear <br />�! 1�,sr ��j ... ; X12"""". y <br />,%"�-i�• �' �v��`� '�; ;y <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ 0mriti Residue <br />ty ❑Type ❑ ❑ Partial Rejection ❑Full Rejection <br />Manifest Reference Number. <br />181h. Atemate Facility (or Generator) U.S. EPA ID Number <br />J <br />U <br />LL <br />Facility's Phone: <br />LOU <br />18c. SignatursofAltemate Facility(or Generator) Month Day Year <br />Q <br />C9 <br />y19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />ou <br />1. <br />2.� <br />3. <br />4. <br />° <br />4 <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printecirfyl6dN a <br />,_--Signs <br />re, l Month Day Year <br />r <br />�- /� <br />I'lA. 1 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO -GENERA R <br />