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Please pant or type,(Fbfnldesigned for use on elite 112-pltch) Ilei j. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Emergency Response Phone 14.Manifest Tracking Numbper WASTE MANIFEST L 6'D Q1 a 0 : 1 ��.., 0 1 7 4 6 8 9 7 2 JJ K 5,GONarlors Nama and M069A tdmss GeaemtoYa Site Address(f(drharent than mailing addressr) FLP i l.l'! kr,JG '.'.01. t UitGrlHRv STi;Er'T r:-=iirit1iT01ti N i 06:c;) Generator'sPnoneE 2L33G CWi� =a 6:T+tin§wner l CompanyNama - U.S.EPA IQ Number iiCPLG IL F N f0 NnL SE RV C E 0- 7.72nspodar2(ampanyName U.S.EPAID Number < 3C 8.Designated p'actlt!y Name and Sna Address U.S.EPA ID Number ASLLiI',1`:='NVlP.CNIv7ENT.=,LaGi:,....c -i"tF :. 3.J 'D top;!',3RP1 Eu ta„ir es Fhona'. - ga, 9oU.&DOT Description(inchiding Proper Shipping Name,Hazard Class,ID Number, 10.Containers11,Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity WtNol. o 1 NON-PCPA HAZARDOUS VAST E, LIQUID(OILf IL,BAI Ell) ) iO w 0 3. 4 0. >pe at HandYa7(rsi s 4nnS and+ri'nfermeuen .,,HEN R°., _.SQrA 2-i .1jl iU_ _L r P L-..__ r 'r .. - r _DQYIPP;ICL Er,itr3LICiSJtlT4vi „17i:1TPrr4 Llil-4"4 ._� -; _f �• ._ 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents offhis consignment are fully and accurately dosed labo by the proper shipping name,and are daesNed,packaged, marked and rabe!edlplacarded,and are in all respects in proper conditior fostrensPed according to applicable inernational androti gMat 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 EPAAcknowiedgmem of Care I. I certify that me waste min � &m tement idami in 40 CFR 2622 a)(if i am a large quantity generator)or(b)of I am annerator)is two. Genr!mto,+s'Olkrprs Primhad VPGd.N il(tSignaturs Month Day Year 16.Inlemational ShipmentsoAL F Import to U.S. Lvl Export from U.S. on pexin__ _ Transporter signature(for exports only): Date lea- U.5 W 17.TranspoderAcknowashimentof Receiptof Materials r: Pc' r t Prmfferufk*Name aide ) �W yew 7 z run5pdttare PrntadlTypedNama Si Q gn Month Day Year K r- 18 Discrepancy - 18a Discrepancy Indication Space ❑ Quantity Residue ❑PaNal Rejection tJ Full Rejection Man7tasl8elararxm Numbar' J 16b.Allarnata Facility;or GenenlfM) U,S,EPA 11)Number U LL Fa©`ldys Phone- 0W .-1"fgn11tur1 olAllemaie FacSpiytor Gsnezriar) - Month Day Year Q Z 19.Hazardous Waste Report Management trlethod Codes{i.e.,cedes forhazardmus waste treatment,disposal,and rscyding systems) 20 Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a ' YKAhl ma Sronalum MGNh Day Year EPA Form 8760-22(Rev.H5) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF RE©!SIRED;