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<br /> k' Pleads pont' <ype,(Form designed fogy use on elite(12-pitch}typewriter.) Form Approved,OMB No.2050-0039
<br /> UNI RNE HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Nuinher'322
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<br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address)
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<br /> GmdratoesPhone: TW1 `
<br /> 6.Transporter 1 Company Name U.S.EPA ID Number
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<br /> 7.Transporter 2 Company Name U.S.EPA ID Number
<br /> dSilWtdsd k&•a a5+ ae y,� US,EPA iD Number
<br /> Faclll 's Phone: 2� ? 13 MI.)fP4 Z2981 i.1
<br /> ga 9b.U.S,DOT Descriptlon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit
<br /> 13 Waste Codas
<br /> HM and Packing Group(If any)) No.- Type Quantity Wtwol.
<br /> 1. '4���� '.�.�. �lE u�:'..i' w�•r i�s��,wn��..i5: k.:�'�.:=�ET..'@.C�.°>a Sr'.,C3a:�,a3«'G:�. -i�{:r n`:a ''.
<br /> 2'. � .;�^ifi`w"9 ��`;':ti'�&,��"t.':§.s� T ."Y»�,, a�f,43,. 's•~s:363�,-%=r r3,.=:i,r• `s�-.`+''
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<br /> 14,S pecJ �lXpol!g Instrucfo s and alnfoation
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<br /> 15 GENEreby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged,
<br /> '68rkepr9per.coriditiori'fortrensport according to applicable international and national governmental regulations.If export shipment and i am the Primary
<br /> uporter,I'ceNfy ftrat4he pontepFsof(ItrsconsEgnmerit_cbuform In the terms of the attached EPA Acknowledgment of Consent,
<br /> t cerilfythattrietwaste mTn6tifahQn 3Yafementddentied tA'40 CFR 262.27(a){if I imp large quantity generator)or(b)(if tam a small quantity generator)is true.
<br /> Geheta Ys1OfferkoY9 Printed/T'yped'NM% Signaturet_'., K f: M�Mh Day Yepr
<br /> �'.``. 'vo��"`Sa'"',�§. r. �Bt�;yy @��•B�� C��•t ititil�i?�h.W.C"t S:J�' i �L�+ '"'�ti.>i�Gt°-f +'�..'� / �t'�1
<br /> ._a 16anternatiorail Stalprr�nfs` � r-� r--� - ,
<br /> :,. ;,-:,: ;s:: ::- t in7port toll<5... ,;. ':•c,' i�J i xport from U:S Fort of entrylexih x;'
<br /> Transportersignature(fol export9'only): Date leaving U.S.:
<br /> 17.7rarisporte�AckhouileQg'mem of Receipt of Materials
<br /> Transporter 1 PrintedtTyped Name
<br /> Signature Montht Day Year
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<br /> TrAnsporter2 Printedityped Nama Si nature
<br /> g r Month ,Day' Year
<br /> 18,Discrepancy
<br /> 18a,oNcrepancy lndioation Space Quant m ❑Type ❑Residue ❑Partial ReiectionQ Full Rejecton
<br /> Manifest Reference Number:
<br /> 18b,Alternate Fadiity(or Generator) U.S.EPA iD Number
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<br /> " U- Fadilty's ftne: -
<br /> g3 18c.Signature of Alternate Facility(or Generator) Month Day Year
<br /> S219.Hazardous Waste Report Management Method Codes(W.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> � 1.
<br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 16a
<br /> Printedffyped Ndma Signature
<br /> Month Day Year
<br /> CPA Form 8700-22(Rev:3 05) Previous editions are obsolete. DESIGNATED r-AC LpTY TO ts",ENERA'f`OR
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