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Please print or type.(Fort designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.20 -0039 <br /> UNIFORM HAZARDOUS 1"31neft,'�'llkNut , , 2.Page 1 of 3 Erre e nrq es se Phone 4.Manifest Tracking NumberY.. <br /> ] 010631 9,18 WASTE MANIFEST L <br /> 5.Generalor's Nam and Mailing Add �T<R r. t/ E G`f rsl_ltr Cj f ft1 ttltlCflRris"F,era+YGil Coanerator's Site Oress(if different than mailing eddress) I�: <br /> El Dorado Sr. <br /> Generator's Phone: dJ 4 <br /> ransporter 1 Company Name U.S.EPA ID Number <br /> 'J '.0 f <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.Designated Facility Name and Site Address U.S.EPA ID Number <br /> �•"�1[ r:{tsr�;tr7)1?�7f3C�1 °;v-�,�1�•t.�zf a <br /> ?i6-AV,,445i 45i tc z t„;, rr.1Df1,�r i� t'�iw MY USA <br /> Faclliry s Phene. <br /> ga, 9b,U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Typo Quantity WWG. <br /> 1. q <br /> t(�Ctri.} +(r` ErC�ct e3a,_... �f <br /> �C1 <br /> 4. <br /> 14,Special Handling Instructions and Additional Ifdormatbn <br /> _11111K,pro,IW1041 16 <br /> 15. GENERATOWSIOFFEROR'S�CEfMFICATiON:!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 Iabeladlplacarded,and a,ta in all respects in proper condition for transport scttvdag to applicable international and national governmental regulations,if export shipment and I am the Primary <br /> Exported,I certify that the contanht of this consignment conform to the terms of the attached EPAAAnowledgment of Consent. <br /> I certify that the waste mini*tidn statement identified in 40 CFR 262.27(a)(if I am a large quantitygenerator)or(b)(d I am a small quantity generator)is true. <br /> Ganoratot eror's Rnledfryped Rama igna rer-- on ay ear <br /> _j '16.international Shipttnsnts <br /> ' ❑Import to U.S. ElExport from U.S.— Port of enr <br /> hylexit <br /> Transporter 'nature(or ex22rtsonl : Date lemi2q U.S.: <br /> W 17.TransponerAcknowledcjrnent of Receipt of Materials <br /> W Tranapoder1.Fnnted7ypadName 9fa ,. Month, Day year <br /> 4 <br /> Transporter 2 Printedffyped Name I gnalure monul Day Year <br /> 16.Discrepancy <br /> 18a,Discrepancy Indication Space Quantity ❑Type ❑Residue �Partial Rejection El Full Rejection <br /> Manifest Reference Number. v <br /> i6b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> ..0 <br /> v ' <br /> w <br /> Facility's Phone: <br /> IK.Signature ofANamateFadlity(or Generator} Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for haiardous waste treatment,disposal,and recycling systems) <br /> p 2. <br /> 20.Designated Factiity,Owner or operator Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Printedffyped llama ; Signature>8 nth D Year <br /> . 0I� <br /> EPA Form 8700.22(Rev.3.05) Previous editions are obsolete. _ SIGNATED FACILITY TO GENERATOR <br />