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I <br /> I <br /> J <br /> Blease print or type.(Form designed foryse.on elite-(42-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Emergency Response Phone 4.Manliest Tracking amtisi" <br /> WASTE MANIFEST f_.j1t(]; fi;3.I? ? )t .123 7':' <br /> 010635956 <br /> LFE <br /> 5, nester's Name end Meiling Address 'tors Address(d d'dferent than maNing eddrem) <br /> t-ffimli wR 54t'-a' c on`a'E limi3 .Ain wtlitaact weri#$om--.a <br /> 3M 13,El Ckradis St <br /> Genomtots Phone; <br /> 61 ransporter I Comparry Rame U.S.EPA ID Number <br /> 7.Transparar 2 Company Name U.S.EPA ID Number <br /> a <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> t'„5_f=11 i~:.fS'tijt-r ?ft"t Pi I 3 t d Ea. <br /> ;;'��) aaF.,>m t <br /> Feclitys Pfron �° 1-` ,ht <br /> Eau Cxbolx UT W20 USA <br /> ga. 9b.U.S.DOT Description(iducing Prrrper Shipping Name,He.zard Class;ID Number, 10.Containers 11.Tolet V.Unit 13.Waste Codes <br /> HM and Packing Group(ti any)) No. Type Quantity WtNoi. <br /> .� ... 1 �.Z Z'4"t# S •*k F`=.�,6 M#xL f._i;3ax a Y"?:.:,s.!�,„Yt.�t.li:I.(C#,�1� �3 �.C',f�9 U 7 ? 1.9=v i't='� .�w;+i � '> . .. ,.::.—�.._.., '.. <br /> 3. <br /> 4 <br /> 14.Special Handling and,Add6orre11nfomiation <br /> a.IiV IPP,AL: Wk ;O�,p�.,,,�.q.0 Y C(40,' "k L^T R,0114,CARI NO # �i �fy K a`�C i j 2. <br /> 15. GENERATORSIOFFEROR'S CERTtFICATtON: I liereby,dedare that the contanis of this atnsignment sig fuly.and aaxsately des toed atwve by .P PP�9 Hama,end afe dasslfled paakagad, <br /> marked and let ed/placardad,and are In.aN respects.il proW can iftlon for transport accondi g.to applicable Mternatlonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter;I ce tify that de contents of this consignment conform-to the terms of the attached EPAAcknowledgment of.Consent <br /> I cer6fyihatthe waste minimization statement Wntified'm 40CFR262.27(a)(If I am a targe 9uantIty.generatw)or(b)(d I am a small quantity:generator)is he, <br /> i era s!' s y—*Nams igna re y_._ ear <br /> tL fj <br /> 1&Intama oral Shipments <br /> ❑imcert to U.S. ❑Export from U.S. Pori of entry/exit . <br /> Tran nalure for exports on : Date leaving—U.S,: <br /> LLJ. 17.TrsnspaterAdS)*4dgment of Recapt of Materials <br /> P iansporter I:PrintecirtypeTName s ..,.,,,..,_,., Y ear <br /> CL <br /> Transporter 2 PilintediTyped Name- z5viiature Month 14y Year <br /> 18:Discrepancy <br /> isa.Discrepancy Indication Space ❑ Quantity EITYP, ❑R.A. ❑Partial Rejection ❑Full Ralection <br /> Manifest ReWmioe Number. <br /> 16b.Alternate Facilry(or Generator) U.S:EPA(DNumtier <br /> �. <br /> FadWs Phone: <br /> ''18c:Signature ofAltemate'Fadl ty(or, nerator) _ Month • Day Year' <br /> 19.Hazardous waste Repot Management Math efldes(i a,;twdssfix tlazardw�was(s treatment,sNsposal,and racy�ng:spstems) <br /> ® 1. 12. 3 4 <br /> 20.Daslgnated Facility Omer or Operator.Certification of recaiptzt#hazardous maietials covered by the manifest exceptaS oMed in Item 18a <br /> Printadtryped Name ignature fanth Day Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete, TRANSPOIRTER'S COPY <br />