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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />Farm Approved. OMB No, 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. <br />DESI ATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS 11. Generator ID Number <br />I j `�V <br />2. Page i of <br />3. Emergency Response Phone <br />`IJ <br />4. ManifesIT raclum Number <br />0"' 0 3 � 8 8 2 4 FLE <br />WASTE MANIFEST r,,, � / � �� <br />P <br />074 <br />5. Generators Name and Mailing A dress Generale(a Sts! A ress (if different than mailing address) <br />ti°�aH u�N cc",Zy r�Lcr</A.�/c <br />�% % ' dif <br />.r <br />G ner rs'Plw� <br />b nspodm <br />er 1 opany Name U.S, EPA ID Number <br />� CF4 ti> /*zpvd I t-1,4 roc) 5-n <br />7. Transporter 2 Company Name <br />p <br />D U.S. EPA ID Number <br />8. Designate Facility Name and Site Addrgss �' U.S. EPA ID Number <br />pit In o., � 'r' l7 <br />JAN 2 2 .2007 <br />' �TtvsP one" ` ^`c � /, cre 7 cs ENVIRONMENT HEALTH <br />93 <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Num e, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />1. F[_Aos,m443ca 4-1aa.tD5� Ai.'Sj 3 uAJ % 9gc=S7Gcl <br />r.Cv N0 C 71Zv'G C i.trr. r c. <br />++�- Dl S it qt=5l7 <br />PC 74eYSZ <br />ETy�e, <br />�W <br />Ql�es���,��,ar"��7^�F57 <br />f2Gj!0Lc <br />7 Al xv 5r z z- <br />0ep <br />coc'10 <br />3.6 e--5 / S u 1 C�,7,v C"ee"q""C/ . <br />CS e <br />late <br />Pr05 AND¢ r�[ (� �x 15 y A 71, 20* <br />-cv-, l <br />Al- <br />a � 0 1.4 <br />fi <br />1CeiJ5L-MA�vj!cma,mn0tfs r L?n-m-D, 417 ft' <br />es -7_N <br />Az) LQ LrAnJ T /-7 )C[iit6,12o���%4957E{ <br />-- <br />-- <br />(,v/ <br />aao <br />i2 <br />14. Special Handling Instructions and Additional Information <br />15. GENERATOR'SIOFFEROR'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 labeledlplacarded. 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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I arfify, that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or ( (if I am mall qua ity gen atm) is free. <br />Generatarsl0 avers Rin Typed Name Signa re <br />f l HA�1 1 u 47 `7k i <br />Monthay Year <br />67kAJ -40 A ui.il& y117-1146106 <br />.-r <br />p— <br />16. International Shipments <br />❑ Import to U.S. ❑ Export),.m .S. Port of entrylexit: <br />Transporter signature for exports only): Date leavi <br />Lie <br />17. Transporter Acknowledgment of Receipt of Materials <br />Tra der 1 Pnntedrr d Named Signature Month ay ear <br />w <br />r <br />u /C�+12 SLI_/:?.. (, - I/ <br />Z <br />Transporter 2 PrintedrTyped Name Signa re �— Doth ay ear <br />rY <br />r— <br />} <br />18. Discrepancy <br />18a. Discrepancy Indication Space ElQuanfty yp <br />LlT e El Residue ❑Partial Rejection Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />U <br />Q <br />n <br />Facility's PAone'. <br />ad <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />Q <br />2 <br />LD <br />19. Hazardous Waste Report Management Method Codes f e., codes for hazardous waste treatment, disposal, and recycling systems) <br />O <br />20. Designated Facility Owner rator. Certlfca8on of receipt of hazardous materials covered by the feanifesl #ceplgs noted in tem fie <br />1 <br />Pit IT ped Name Signal a Month Day Year <br />I ob <br />uflM,J z <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. <br />DESI ATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />