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..Please print or type'(Farm designed for use on elite(12-pi(ch)typewriter:) Form Approved.OMB No,2050-0039 <br /> 1.Ganeralor ID Number 2:Page"1'of 3.Emergency Response Phone d.Manifest Tracking Number <br /> UNIFORM HAZARDOUS �. <br /> WASTE MANIFEST f1(i Cl(y f %t, CI 7` PCO)42j,,:0;1300 :� :w rC G �� �� <br /> S.Generator's Name and Mailing Address (3enerator's Site Address(if different than maijing address) ) <br /> PEP'O-XjfS 84,'W is <br /> HAMIM-01r a; N 1401 SOUTH CHEREfKEE LAM u <br /> Generater'sPhone; »13 u7st� f 1.,4x#3( 0A 935240 <br /> r <br /> S.Transporter 1 Company Name U.S.EPA ID Number <br /> LP.?IORL ; <br /> 7.Transporter 2 Company Name U.S.EPA lD Number <br /> l;`Vt r 030-4li0E~REL;.)VEW-i SY:al BA 044", ;A V 0 t'.]f':f 5 4 2 2 <br /> B.Designated Facility Name and SiteAddressU.S.EPA ID Number j? <br /> Yf.nY:.�F MA,F�s <br /> Facility's Phone: <br /> ga. 9b.U.S.DOT Description tincludiag Proper Shipping Name,Hazard Class,ID Number, 10,Containers 19:Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Val. <br /> �+ i'�VfY-'1`•�k'E:;�`4 3VVAT1L.S'i LJS�081k;SOLD(PAPER <br /> 0M � t P <br /> 2 Z. <br /> rLr <br /> {i <br /> 3. 1: <br /> 4. ryE <br /> If <br /> 14.Special Handling Instructions andAddillonal Information <br /> 15. GENERATOR'SfOFFEROR'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, <br /> marked and labeledlplacarded,and are in all respects In proper condition for transport according to applicable International and national governmental regulations.If expert.shipment and I am the Primary <br /> Exporter,I cern y that the contents o1 this conslgnmenl conform to the terms of tho attached EPAAcknowtedgment of Consent. <br /> I certify That the waste minlmixallon statement identified In 40 CFR 282.27(a)(If tam a large quantity generator)Rr(b)(if I am a small quantity generator)is true, <br /> GenaralerstMerues.PrintediT ped Name Signature A ns Month Day Year <br /> yj <br /> —� iS,Inlemalional5hipments <br /> I-- ❑Import to U,S, ❑Exper{from U.S. Pori of enlrylexll: <br /> Transporter signature(for exports only): Date leaving U.S._ <br /> w 17.TraospoderAcknowledgmentofReceiptofMaterials <br /> s' SI nature s -- Month Day Year <br /> r <br /> Tragspo orIPrinledffypedNamq <br /> .A: ext ; t ;., ..___.. ;..w <br /> TranSff9fter22rinkedJlypedName Signatura � Month Day Year <br /> 18,Discrepancy <br /> 18a:Discrepancy Indicafton Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Ailemate Facility(or Generator) U.S.EPA TO Number <br /> J_ <br /> U <br /> tj- Facility's Phone: <br /> 18c.Signature of Attemate Facility(or Generator) Month Day Year <br /> t19,Hazardous Waste Report Management Method Codes(Lg.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1, r 2. 3. 4• <br /> 20.Deslgnaled Facility Owner or Operator:Coriificallon of recelptof hazardous materials covered by the manifest except as pcted in Itarn 18a <br /> rdntodflypad Name I Signature j Month Day Y7) <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. s DESIGNATED FACILITY TO GENERATOR <br />