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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11.Generator IDNumber 2,Page I of 3.Emergency R6pDnse Phone A.Manifest Track Number <br /> 1,f),0 A 0 7 <br /> WASTE MANIFEST <br /> J �4 89 JJK <br /> L <br /> 5.Oa <br /> gAddress Generators Site Address(if different than mailing address) <br /> 0 PCHAN D 8T R ELI' <br /> NJ GUM CHO-1101TE UVE <br /> LON <br /> Goner aloes Phone: CA, W2140 <br /> 0,T"T.011114A�0(")r1l.75VITR()I�11 mi q U.S,EPA ID Number <br /> 4 A D 0Y 0 3 0. <br /> Ir <br /> U.S.EPA ID Number <br /> I,'A P 0 110 1 A 2 <br /> e.Oesigppaled Facility <br /> Name and Site Address U.S.EPA ID Number <br /> Y U11 A <br /> FadliVs Phone: (92i .4,qi,; A <br /> 9a, 9b,U.S.00T Description(including Proper Shipping Name,Hazard Class,ID Rumber, 10.Containers 11,Total 12.Vol <br /> 11 Waste Codes <br /> HIVI and Packing Croup(if any)) No. Typo Quantity W1.1vol. <br /> MAj?AR00118 k:tYh!.';TF. (PAPFRI M,TERS) <br /> 0 <br /> ................. <br /> .......... <br /> 4. <br /> 14.Special Handling Insfmclions.and Additional Information <br /> G(311""'i"! CKIW(RE-0 1'.800,421"'J"100 WOE'S TERMNAL OF-RES 08 PROFILE P-W! <br /> PAPER FILTUR8 PINE F <br /> QUIPNIENII/ <br /> I.X <br /> 4 <br /> 16. GENERATOIrSIOFFERORISCERTIFICATiON: I hereby declare that the contents of this c.onsiginthent are fully and accurately described above by the proper shipping name,and are classified,packaged <br /> marked and laboledtplacarded,and are In all respects in proper condition for transport according to applicable 101amationaland national gOVOMMOntal feglUM40113.If export Shipment and I am[he Primary <br /> Exporter,I cadily that the contents of this consignment omform to the terms of the attached EPAAcknowledgment of Conserd. <br /> I certify that the waste mInImIzallon statement Identified In 40 CFR 262.27(a)(it I am a large qi)anl!V generator)or(b)(if I am a small quantity generator)is true, <br /> Gaperator'slOfforoes PrIalad/Typed Name ill aluro Month,, Day Year 1� <br /> rj 16.Intemailonal Shipments Import to U.S, El Export from U.S. Pod of enlrylaYll: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> LWis 17.TransporterAcknoMedgTent 9f Reoelpl of WBPIg <br /> W TransporterI?Tted[Typed.Namb Signature <br /> 0 VjJ <br /> It <br /> V(V VP v ( , " <br /> a. 'i:A <br /> U) <br /> Tian Br . <br /> ief 2 Prfrit07ypsd Norlde Mqn1ft- pay lye4r'..� <br /> y <br /> 18,Dtscrepap4y <br /> 188.niscrepancy Indication Space <br /> 11 Ouanlity EIType EIR.Sid'.. El Partial Rojectlon F1 Full RIJ..Il.n <br /> r <br /> Manifest Reference Number: <br /> 18b.AllernalD Facility(or Generator) U.S.EPA 10 Number <br /> Ly <br /> W FacilitYsPhono: <br /> 18c.Signature of Alternate Facility(or Goneralot) Month Day Year <br /> 19.liozardousWiosle Report Management Method Codes(i.e.,codes for hazardous waste treatmorit,disposal,and recycling systems) <br /> 1. 1 t 2. 3. 4, <br /> 20.DeslilpatedFacility Owner or OperalorCertillealion of reMplof hazardous materials covered by the manifest oxcjIii*noted in Item illa s <br /> Plintedfr7,d Na a Signature <br /> I �onth �Day Via r <br /> lt. <br /> a•..A: <br /> EPA Form 8700-22(Rev.3-05) Previous edltlons are obsolete. DESIGNATED FACILITYTO GENERATOF1 <br />