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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone �ManifestTracking NumberWASTE MANIFEST � � �� 1 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) FLE T1a4C�lt�r c4C'�1�51'i'11a "t0 0 4r1dI StrieJ QI" storktnn. (A Generator's Phone: _,. 6.Transporter 1 Company Name U.S.EPA ID Number A"Med Ummit*t14 TMnSpMt kti,,tpBA ACTarivo 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number 8r Facility's Phone: "203 9a. 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes No. Type Quantity Wt.NOI. 1 JN3244,Waste:Sra6ids c onia-fining corrraa-;ive Ill t�ticl,mo. 3: I o (NYdroclllir>:ric Acid,AK%orterjt),8,PGO LU W 2:t . 324#,:rsabds c 6rctair6ng t otra•;aiv+e lig1,n.o.s. cD1 ; f4ydrof4t10r0S&:add,AbbrarlwnF),8,PGB s.,• n� nnmerNa aa.maoos, ;fib-%Minc es.-.01lia- it.—T. X41 i'COPP'r Suga3t£`),8,PGCE I 4:4 JN3244;Waste So4ic4s containing c:ntxrM--,fVt,- tid,mn,,: p 15illfulmus acid.Absorhwr ),8,PGR 14.Special Handling Instructions and Additional Information P�m}ect klt.VrttaEtr zT,Mst L�su;ume�r�` 3)ERG#17 I THU. �•+^ `:.r s:',:: 2s ERG#154, t?1r-T928"-3UM 7HLIF-- 4)ERG#154; 070127425-1466 HIJ� 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifl am a small quantity generator)is true. Generator's/Offeror's Printed/I yped Name Signature Month Day Year J 16.International Shipments Z ElImportto U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials w � Transporter 1 Printed/Typed Name Signature p r. Month Day Year ZTransporter Printed/Iyped Name Signature Month Day Year f- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection 1 El Full Rejection � 18b.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number J U L Facility's Phone: La 18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O 1 2. 3. 4. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY