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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form proved.OMB No.2050-0039 UNIFORM HRDOUS age 1 1,Generator ID Number 2.P 1 of 3.Emergency Response Phon® 4.Manifest Tracking Number WASTE MANIFEST AA —I AZA -1 004992978 JJK v 5.GeneraIon Name Mali g rGenerator's Site Address(if different than mailing address) Mfwz Generator's Phone:-20,0� M0 6.Tr sporter I Company me U 111 LL= U.S.EPA 10 Number 7 7—Transporter 2 Company Name U.S.EPA ID Number 8.Dqlignated Facility Name and Site Addre s huN VIC14 I FILMLI I I U.S.EPA ID Number awl PERMIT/SERVICES Y'4. Fac'OpZe: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No, Type Quantity Wt.Nol. 20—L Zo- 0 1— or-3 2, Z-/ zw X-3 3. 4. 14.Special Handling Ins coons and P,ddi6onal Inf rma'on 5. GENERATOR'SJOFFEROR'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, marked and labeled/placarded,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 Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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 true. trat&sIGIferor's Prin tedfTyped Name lure Month D Year -4k'r ? ZE!Lv� 17 16.International Shipments F. 0 import to U.S Export from U.S. Fort of entry/exit: Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials TranwPAer I Pnnted/Typed NamesSi Lure Month Da Year 0 z Transporter—2Pnntedrryped Name re Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Qu.ntity ❑Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number Facility's Phone: U8 78-77—ignature of Alternate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 2. T- o 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)