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W� �IWNW�WN��WNWIIWINW <br /> se print or type.(Form designed for use on elite(12-pitch)typewrites) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.!oemlm'IO Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number <br /> WASTE MANIFEST yTy;(0�,�7di.3yuj7 g &77;:rM-669 008980801 FLE <br /> 5.Generetork Name and Mining Address Generator's Site Address tit minimum man mailing address) <br /> B ;..P <br /> Ge andoes P)1nnC L ,.1 s Ct" '24th !'.y, ' `n '' <br /> .Transporter 1 y Name US.. EPA ID Number <br /> 0is wa5 t i7t} i1t A0[is LtfC 1'41V7 t3 1 -4':1 4 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> B.Designated Facility Now and Site Address RF, .,".31 E i!v i r,a ri'v P ml n a tAgt., iU.S.EPA ID Number <br /> , <br /> 11855 W?iaF.e tRU%H Rawl <br /> (3p 9574-2 <br /> Facim's Phone: �xc :✓t.-°u`1 :i;D96> 864 .63 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, to.Cwnairiers <br /> NM and Packing Group(if any)) N.TOIzi 12.Una 13,Waste Codes <br /> N0. Type Quantity WtNol. <br /> 'i ti r:Ti N4fY4 f?.A.zaUii.s. 1. tnili. _.-;:E :.,`' 1 t <br /> Z 2 <br /> w <br /> t7 <br /> 3. <br /> 4. <br /> 14.SpeclalHandliFglnsbmMandAddi6onallnformdm 1. 1.:411 ',''CM .e , egu at;fla _..iQ�drist <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I tereby declare tlmt the contents of this consignmentarefully and accurately described above by the propwshippmg name,and and,dassified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport accdrdirg to applicable international and national governmental regulations.if ex <br /> pori shipment ard I ani the Primary <br /> Exporter,I certify that the contents of this consignment mlrconn bthetenns of the attached EPAAdrnowiedgment of Consent. ' <br /> Icerdfythatmawasteminimizaflonslatetnentidenffwdin4n CFR262.27(a)fglamalwgequandtygenerator)a(b)(dlama Tuan r)is <br /> enaratofs/0 r s nnted/ryped.Name tin ay year - <br /> C Daw at , <br /> -.r 16.Internathifind Shipments - - <br /> F ❑l rodalc U.s. ❑Export from U.S. Po en /not: <br /> z. <br /> Transportersignature ifor ex ns Date leaving U.S.: <br /> WW 17.TrarsporterAcknwAedgmonl of Receipt ofMatenals <br /> yf'. 1ranspgner 1 PnnteNrypad Name Ign.ure -..,�..,...,... y Year <br /> Op'-.`I S'r (-k.2 mAflza 'd1c �' 1 <br /> M <br /> QTransporter 2 Pnnted(lyped Name g re ay ear <br /> K <br /> H <br /> is Discrepancy <br /> 18a.Disweparky Indication Space ElQuantity 1:1 Two ❑Residue ❑Peru Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> F tab.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fadli s Ptmne: <br /> w l8c.Signature afAaemale Facility(w Generator) Montle Day Year <br /> a <br /> z <br /> h 19.Hazardous Waste Report Management Method Codes(:e.,codes for hazardous waste ton strumt,disposal, cydim <br /> l,and regsyslems) <br /> O 1. 2 3. 4. <br /> 20.De"labill My Ower or Operator.CeNflcation of receipt of hazardous materials covered N Bre manifest except as noted' rn l8a <br /> Prmtedfl' time Signa Month Day Year <br /> O <br /> EPA Form 8700-22 Rev-n-05) Previous ed8ionsa obsolete. ESIGNATED FACILITY TO t S NATION STATE(IF REQUIRED) <br />