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Form Approved.OMB No.2050.0039 <br /> Please prift nrtyp,r(Po€m designed for use on elite(12-pitch)typewriter,), ; 4.htantiest Tracking Number <br /> UNIFORM HAZARD0U5 1,Generator ID Number 2.Page 1 of 3'E€nergency Respanso Phone er_ t"4JJ K <br /> WASTE MANIFEST C A 1,O k3 0 19 4 3(t 7 } <br /> 5.Generalats Name and Mailing Address GarterW. <br /> atorS;SfleAddress{If dtHeren!than marring address) <br /> PrF,WY33 R105-52 <br /> 210'1.t~ORVAJAPHO STR,t# y II FF q( ) <br /> �F;E�rt' :��s.�tl:.:•. ..: .. .... .. ..�,! t��l r ' ! <br /> t 244) <br /> LON <br /> Generators Phone: _ :EPPiDNFther <br /> }; <br /> 6,Transposer 1 Company Name 'MH LV7ERVICM <br /> --VOPLID.01L ENVIRON X-1 ITA., <br /> U.S.EPAID Numher <br /> 7sTranspaser nlpp N _. ,, -17 54' <br /> 04 A D <br /> U.S.1 PAII)Number f <br /> B.Designated Facility Namo and Site Address ' <br /> YE-N)fa ANA',x NAr- 4T,ft i,'. <br /> Facillity'a Phone: (p,261;;r14aw[ <br /> 10,containers 11.Talal 12.Unit 13.Waste Codes <br /> ga 9b•U,S.DOT.Descopgort(Including Proper Shipping Name,hazard Class,ID Number, N Type 4tlantily WL.fUat, <br /> No. <br /> iT <br /> HM and Packing Group(if any)) , <br /> N-i<C' A 141VARt OU-rt W��t E.-SX11.111(�E��f�� <br /> V R— a <br /> 14.8Rre4 Handltirg Instructions and Additional Information <br /> .t M1 <br /> i F,�kRWI!i' a.,e+ <br /> re <br /> er <br /> pping Ramo. <br /> are classified, <br /> y and <br /> 15. GENEt2ATOR'StOFFEft O dCand are allQespe�respects prope€condition fomutants <br /> transport according ngto applicable itte national ansd national gone nmanlatr regulations.If f export shipnn l and t am the ptfmaryd <br /> marked and labeledlp <br /> generator)or(b)(if am a small quantity generator)Is true. <br /> Exporter,I certify that the conlenis of Ihts consign <br /> ment conform to the terms of lire attached EPA of Consent. Month <br /> 1 cedify that Bre waste minimizallan statement identified to 40 CFR 262.27(a){if t am a large quantity Signature ` b <br /> Generato#sfofierors PrinledlTYped Nd¢rre �'" 5�" <br /> l• c `. l <br /> 16,intemattonal Shipments impod to U.S, ❑Export from U.S. Port of entrylexit <br /> Date leaving U.S.: <br /> Transporter eignalure(for axporfs only}: <br /> W 17.TranspolterActrnovAedgmenlofReceipt OfMalorialsLU <br /> Signature r` �._ w —�. ..,, Month Day Year <br /> Transporter 1 ponlediTyped Name <br /> or �•'� �,c, = s,,. " <br /> _ ._,.• <br /> � fLrO Month bY Yoa <br /> Snaku?e� <br /> z- a porPsinledlTyped Nand•i <br /> 18.DlscrepancY ❑Paslat Rejection Full Rejactton <br /> 180.Discrepancy Indieatioit Space Q Quantity <br /> Type ❑Residue <br /> Manifest Reference Number: <br /> U•5.EPA ID Number <br /> r�"- 1 Bb.Mlemate Fatuity(ar Generator) <br /> Month Day Year <br /> w Facilites Phone: <br /> {8c,Signaluro of Alternate Facility(or Generator) " <br /> 19.,HazardousWaste fteportManagemeniMethatiCfA66qM; R-M- acg y+ a r�fs�osri aritf7"ecyclingsystems) d.' <br /> 3." <br /> materials covered by the m <br /> 20,Designated Facility Ovrner or operator:Cedigcallan of receipt of ha3ardous Slgn tufe�pt as sired In fleet 180 <br /> onlh Day Year <br /> PrintedlTyped Name- III <br /> AC1LlTY TO GENERATOR <br /> EPA Forrrt 8700-22(Rev.3.05) PreVlOUs editions are obsolete, <br />