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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Track' Num er WASTE MANIFEST X# 1 G B F 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Ike ,M :;,AIRY ',A F_ MAIN S I Generator's Phone: el ON.ti:A 9fi1Ub 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8 Designated Facility Name and Site Address U.S.EPA ID Number I"AA YLS 2 WASiE TRANSIFER FACKI Y b6W US Nt(3MMAY 435 Facility's Phone: YLII 1A'AZ ' 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes 1. No. Type Quantity Wt./Vol. 0 Pd *f-R<.' to f-!A?ARCNY. I F, mit j ID,AfTSM6HN'T;:,UI4,. W Z 2. W 3. i 4. 14.Special Handling Instructions and Additional Information Ft01 iT f# A�i.'»GEtiFN"r,Gill, IrR 1 11 ,.MERt"EWY CON I A(;r: i(A-w 15. GENERATOR'S/OFFEROR'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 EPAAcknowledgment of Consent. certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or (if I am a small quantity generator)is true. Generator's/Offeror's Printedayped Name ( Signature Month Day Year fit ! 16.Interna onal Shipments` Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: X 17.Transporter Acknowledgment of Receipt of Materials W Transporter 1 Printed/Typed Name x Signature •- O ,. Month Day Year Z Transporter 2 Printed/Typed Name Signature Month Day Year t^ 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection 1 ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: ::3 U.S.EPA ID Number U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) a Month Day Year Z Cn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ 1 2. 3. Notice: State of California requires generator to photocopy and mail to 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a DTSC with 30 days: Printed/Typed Name Signature P.O Box 400 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. Sacramento, CA 95812-0400 GENERATOR'S INITIAL COPY