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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. \ 1 , , 6 S164ATED FACILITY TO DESTINATION STATE IIF REQUIRED) UNIFORM HAZARDOUS i Ge�nferator ID Number /� (AN I/ 10ov 2. Page 1 of 3. Emergency Response Phone 4. Manifest Track' Number 0 0 0 3 8826 F L E WASTE MANIFEST 6—o - mss- y_. 67 0 5. Generators Name and Mailing Address Generators Site Address (if different than mailiinng address) Wi-10LA1vuI") C,%Jrj-r `i L.0v4 �c N5WAL 57,47/CHV "w44FFxr, lBfv C�'.iaAL=L7o r Z343 r Pili �� AlAnr M oP533V e erators Phone: 75�7o E 7rznspoder 1 ompany N 1 U.S. EPA ID Number CLeArt HiI rNKt?0A/AiFr✓11jr, 5 07AV(9-b1.3 76-o 7. Transporter 2 Company Name U.S. EPA ID Number JAN 2 2 2007 B Desi nated FacilityN a and Site Address U.S. EPA ID Number ylr�toAp ul7 py1fiW cl' ENVIRONMENT HEALTH )5Jr n5 rz/► r32/»ePAO PERMIT/SERVICES F�aE�1tyy MzplV,LAa 9 '`' C„vt�r//U'0/& ,141 ga g6. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10Containers 11. Total 12. Unit 13. Waste Codes No. Type`-' HM and Packing Group (it any)) Quantity Wt.IVid. FcnnnAB(& L/d...p5 K'n�3j Nl - ev rp/Z (AvCtdyer,/ PG,70LJ-M. V,-57/LG-4 ,p /- 7Yg62v UO3 r oa So zdid 2.•'t� r=Sjl frx'S4fqu,�/Fr.,aM Cc 7oxrt/3j -I ES -7 61l (0.1/ Ltd 3o pGTllCW LiA"'F 7rz�,..r I �c , MC7 F 4v5 a va�� 1' x'�fl 3C -1,C, l 1.1 Uaur�� r�AlvlC- Nc5� Es7 brz Pbjl,(Ah ifA)��%a6f)CP��HyS�zs/ 4. Lc/YS(<MGILC�TA1 YRbl bfi(+f-/7 AE/t�✓�jc5 C g� 6CZ (1-rwr r 1.'PQY A A/ -% I9.5a1 E2 /-t-3 es % xf Sl�?) 14. Special Handling Instructions and Additional Information 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment am 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 tar transport according to applicable international a tional governmental regulatlons. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgme t of Co nt. I ceNfy that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator or)b) a small quantity generator) Is true, Generators/Offerors ted/Typed NaSigns on ay Year 6 on�7 17- Lltl+a N up J Co wAl� 71 j z 16. International Shipments 1-1 Import to U. S. ❑ Awn, froryQl.S, Port of entry/exit: — Transporter signature (for exports only): ✓ D ea U.S.: w 17. TransponerAcknawledgment of Receipt of Materials Transpone 1 PrintedlTyped Na a ignalu on ay Year yA� 2271/' Transporter 2 Prmedlfyped Name - Signat re MonthDay ear d' h 18. Discrepancy 1 Be. Discrepancy Indication Space F]Ouenti ty Type Residue Partial Rejection Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number v LL Facility's Phone. w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z w19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 0 1. 2. 3. 4. 20. Designated Facility Ow er or Operator Ceddication of receipt of hazardous materials covered by the mantles exce as n ted in h 1 Pnnte�tt e11d Name Sign re Month Day Year illl EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. \ 1 , , 6 S164ATED FACILITY TO DESTINATION STATE IIF REQUIRED)