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pnrm Approved. OMB No. 2050-0039 <br />'leaseprint or type. (Form designed for use on elite (32 -pitch) typewriter.) 2 Page 1 of 3. Emer ting Response Phone 4. Manifest Tracking Number <br />Q (� <br />T. G tidal ID Number /��� -� — 9 y O O O 5 $ 1 O �+ F LE <br />UNIFORM HAZARDOUS <br />4 <br />L� \� `� �J r <br />WASTE MANIFEST I 1 1 I U 0 1 L 4 <br />5. neratols Name end M.fig Addre c� Gene atofs Ste Address (d diflerenl than coming address) <br />ti N: t mt7/u Anr.irr t� z, ,x t,� .�c:t (f;a,f ; (fiC(y c l> del I�zcrrtiLLc lk% <br />..Cln, Unl 0; R IIIA <br />rsH-zlc�l�IAzn-` <br />8 >` • <br />1 L .y`r `� J ap l - . <br />Gealb7sPltd�e�i U.S. EPA ID Number <br />6.2nspoderl company Name _ <br />-G ,.✓l cn <br />U S. EPA ID Number <br />7. Transporter 2 Company Name <br />8. sgnated Facility Name spd Site AddreLgs. U.S. EPA ID Number <br />lf� IiLii f'•`r pyr�l%' So -wce <br />Fi��rnea^ICGn C.II�C.Le <br />tagol AtZ —I t 13Cy } 61u3 Ii l" , �l N iqa' <br />Fa <br />9a. <br />9b. U.S. OOT Description (including Proper Shipping Name, Hazard Gass, ID Number, <br />10. Containers <br />11. Total <br />Quantity <br />12. Unit <br />WLNoI. <br />13. Waste codes <br />HM <br />and Padding Grooup(ti any)) <br />No. <br />Type <br />K <br />i IQIri'ilru.l-7 h',LIC) nl. iJ: t�.,, �.IN F'c-1 Tc, <br />0 P <br />-> <br />lXla <br />'v <br />001 <br />2.Flammdbie ',Ilc�.`�,Or�al�lc <br />4 I <br />F1gf))rublt)loxlc..� <br />`� <br />; <br />I <br />�;.�i"A <br />N �. <br />m�snStC'h-I fttnj.JI) ,)t'sIN .a, <br />t?G' y <br />0(77<- <br />jn-�5oai 1) <br />5lve Currb�z <br />N4 <br />Infoabon f' <br />14. Speclal Handling Insmons an Addition nn <br />I.) 1445,?c).-2- F- a.) r)H45Q1 62-f7 2")'�'4y —5 (Y-1 <br />:JIj�='S-f•�i� <br />15. GE NERATOR'SIOFFEROR'S CERTIFICATION 1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and aredassified, 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 caddy that the contents of this consignment wntorm to the tens of the attached EPA Acknowledgment of Consent. <br />I cattily that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (111 am a small quantity generator) is true. <br />Genedd6 slOBero s PontediTyped Name ignal�: , on ay Year <br />1amfl 13 1c, <br />—1 <br />F <br />16. International Shipments <br />❑ Import to U.S. ❑ Export from U.S.. Pod of entrylexil: <br />Transporter signature for exports only): Date leaving U.S.: <br />w <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transportert Pdnled7T Name <br />ignature on ay ear <br />Ca, I I L <br />d <br />A <br />=V -\%C' o <br />W <br />ad <br />Transporter 2 PrintedlTyped Name t ign re onlh ay Year <br />K <br />18. D=epancy <br />I <br />18a. Discrepancy Indication Spam El ❑Type ❑Residue Partial Rejulmn ❑Full Rejection <br />Manifest Reference Number <br />(~ <br />18b. Alternate Faaliy (or Generator) U.S. EPA ID Number <br />J <br />V <br />LL- <br />Lot b Phone. <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />aw <br />2 <br />h19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />3. <br />4. <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item Ise <br />PdntedrRyped Name Signature Month Day Year <br />EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />