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Please print or type.(Form designed for use on elite(12-pitch) iter.) Form Approved.OMB No.2050-0039 1.Gener for ID Num•er 2.Page t of E rg nc a ponce P o9e 4.Manifest Tracking Number UNIFORM HAZARDOUS a; 7� 'g r ' Q Q° JJ K WASTE MANIFEST :f "?'� 5 Generators Name and Mailing Aftess Generators Site Address(if different than mailing address) t t,, ,1„ ",� � ,�M.�.�;.vz;.t E:,S>nt�:v ;f�saC�t" E1 3 '•.�lc::F' Generator's Phone: 7ir," <+Watt 6.Transporter 1 Company Name - •� rW CEPA ID Number 7.Transporter 2 Company Name MAY 2 0 S.EPA ID Number 8.Designated Facility Name and Site Address USS.EPA ID Number ft,d Ii EP+11!it�t7r�irV90.AL ric, l \V ,-� ,"..a�� T - �.rk1Y1 rk4B• I' iArR.?MK4T0,Ct.. 94 1 ._• _ Facility's Phone: " ga 9b.U.S.DOT Description(including Proper Sl ipping 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. O i Z 2. T-L j U.1 3. 4. 14.Special Handling Instructions and Additional Inforri ation aE+t ft't!i;}r t f?'s f'I fir Ft17�47 t HAHIM EKS TO K'SIV001 ANO M APPRti'Y"A PPV r:P cC,NC+'f rV.1f r ;t,;t; Ff t:tl�r.!f°•:tFn1! i ts'rti t�' 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, marked and labeled/placarded,and are in all resects 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 consig ment conform to the terms of the attached EPAAcknowtedgment of Consent. I certify that the waste minimization statement id ntified in 40 CFR 262.27(a)(if I am a large quantity generator)or b)(if I am sgAll quantity generator)is true. G erator 0 e rs P ted/Typed Name , S n re L h y )(e ^ i (( t_. 16.International Shipments ❑Import to U - ❑Export from U.S. Port of entrylexit: Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Material Transporter 1 PrintedlTyped Name Signature ce O CL QTransporter 2 Printed/Typed Name Signature Month Day Year t- 18.Discrepancy 18a,Discrepancy Indication Space ❑ quanti ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S EPA ID Number J U Facility's Phone: W 18c.Signature ofAfternate Facility(or Generator) Month Day Year Q Z rn19.Hazardous Waste Report Management Method es(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJ 1 121 3• 4. 20.Designated Facility Owner or Operator:Certificatloh of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedfryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions ar obsolete. GENERATOR'S INITIAL COPY