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Form Approved. OMB No. 2050-0039 <br />,4 print or type. (Form designed for use on elite (12-pltc ., , rewnite I <br />fo O Trackingu� Q F L E <br />b GGGgggnerator ID Number/� 2. Page 1 of 3. Em/elrgnency Response Phone 4 M000358787 <br />s o <br />UNIFORM (Y NII I I �-lJ I <br />1'Z 44 <br />MANIFEST <br />WASTE MANIFEST Vn <br />5 G ators Name and Mailing Address G e t s Sit Address (If different than mailing atldress) <br />' tmPa'tzA VAPLUS <br />rlC 3C�i '(In Q nty San &if-) 4OUSehold W6Zarz�u5 0 q!46 <br />l p (��0� <br />lrl c{5aC)l 61D �czC <br />ld� a� ,2 <br />Genera r' U.S. ID Numher <br />6. TM spoiler 1 ompany Name — O <br />I (1 ° �9 <br />l n u <br />U.S. EPA ID Number <br />7. Transporter Company Name <br />S. Designated Facility Name and Site Address U.S. EPA ID Number <br />Clan Narbors tnulronrne4al Serouz) Ina <br />,voq 1 -an Groes /�iZ D (��f ' i q <br />(Arne <br />PFor�EW <br />. U.S. DOT Description (inducting Proper Shipping Name, Hazard Class, ID Numher, <br />10. Containers <br />11. Total <br />Quantity <br />12. Unit <br />Wt.fJol. <br />13. Waste Codes <br />F9b <br />nd Packing Group (if any)) <br />No. <br />Type <br />F n,�mable L1�i 4 ds,►Jr)S- 3,un iGG3 pG a <br />gaSollne; ace+cYne),(e�g f a8)Cp�: ��1979) <br />Ove <br />C <br />z2. <br />aln� 10.+er100. 3,un 16*3,P6 <br />�, <br />(nl a <br />N/A <br />( <br />(Doi sa)ii�ayJl(e�q f ae) Cp4 �4<15a�) <br />p� <br />e F <br />Cxi�r55 <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />(a Ue�gGr1G 3X 55 Dm <br />Jc�11 5a4 Sx m6cF <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare mat the contents of this consignment are fully and accurately described above by the proper shipping name, and are dassified, packaged, <br />marked and labeledlplamoled, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If expert shipment and I am the Primary <br />Exporter, I cemty that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is we. <br />Generalals erofs Printedflyped Name Igna ure on ay Year <br />/e 1 di 14�e <br />ifi.lntema6anal Shipments <br />❑ Import to U.S. ❑Export from U.S. Pon of entrylexit: <br />z <br />Trans orter si nature for exports aril : Date leaving U.S.: <br />ILLI <br />17. Transporter Admowledgmenl of Receipt of Materials <br />natureonth ay Year <br />OTran <br />1 PnnletlTr ed Name <br />6 <br />Transporter 2 PnntedRypetl Name Sigure Month Day Year <br />C <br />k- <br />18. Discrepancy <br />18a, Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Panial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility lar Generator) U.S. EPA ID Number <br />7 <br />U <br />LL <br />w <br />Fadli sPhane: <br />18c. SIgnaWre ofAllemate Fadlity(or Generator) Month Day Year <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, tlisposal, and reading systems) <br />WQ <br />1, 2. <br />20. Desgnatad Fadlily Owner r Operator Cedification of receipt of handous materials covered by Ne manifest except as noted in Item 18a , <br />Year <br />PdnledlTyped Name Signature Monty Day <br />oc Itnocn <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. UtZjIUNAI tU t-Auu I T I u uw r Ilrrl Ivry a IMI c p. <br />