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FILE COPY <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB filo.2050.0039 <br /> UNIFORM HAZARDOUS i.Generator ID Number I 2.Page 1 of 3.Emergency Response Phone 4.ManifestTraokin N mber <br /> WASTE MANIFEST ;. l,t£4)I f�s3li -977 <br /> 6,Generatoes Name and Mailing Address Gen®ratces Its Address(if different then mailing address) <br /> t.tf>)ir.l;R;�AL�j'4 RECYCLING CLING f4f tillant f4enaomif <br /> Stockton,GA 95206 <br /> Generator's Phone: 444-0w <br /> 6.Tmns #er oranyName U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designated Facility Name and 9de Address U.S.EPA ID Number <br /> : f- <br /> <,Drte rf ifY7f1Tt1§lnW t"I re go,33a a 2120i <br /> 111 f 4VeSt FfiglVay 1 3 <br /> Facriity's Phar <br /> tit rust Carbon,UST' 845210 UtiA <br /> ga <br /> Ob.U.S,DOT Description(Including Proper Shipping Name,Hazard Class,10 Number, t0,Containers it.Total 12.Unit <br /> HM and Pad&Q Group(d any)) No. Type Quant#y WtNol, 13.Waste Codas <br /> 1 61` <br /> � ; , e..,.;ice ,i.�artr�,•�r a r <�'s— nor r+ T t <br /> Y rr r '. rtra ru ,a 1z? �s�r t C: C I# (a [)C)s.rec, . d &2..I <br /> 2' <br /> 4. <br /> 14.Special Handling insfnnct ansand Additional Information' <br /> mutl*Fckk stweddef <br /> DO PMMOA04116;6405 <br /> 16, GENERATOR'StOFFEROR'S CMINCATION:I hereby declare that ft contents of this oonsignmarnt are holy and accurately 4esa#bed above by the proper sapping name,and are classified;packaged, <br /> marked and labaledlplacatded,and are in all respects In p opet condition fortransport acoxd ft to applicable intematlonai and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this ionsigranam conform to the terms of the attached EPAAdmowlecigment of Consent <br /> I certify that the waste minimization statement idehilfied in 40 CFR 26227(x)(d I am a 4arge quantity generator)or(b)(f I am a&Td quantity )is true. <br /> an sMn Name bignspire Day year <br /> ;` ; I A <br /> vs 16.In#emational Shipments <br /> h ❑lmpon to U.S. ❑Export from U.S. Port of antrylexitt <br /> Trampxlew signature&tx Date h iN 0.S,: <br /> IX 17.Trans rAc <br /> pate Igpwledgnon#of Receipt of Materials <br /> #C� Transporter 1 RntedlTyped Name nature m y oar <br /> l1 f > 1�� <br /> j Transporter 2 PrintediTyped Name Month Day YeaF <br /> s <br /> 18.Dis Wnay <br /> 90x.Discrepancy Indication Space 0 Ouartily ❑ly{w Rssdua ❑Partial Rejection ❑Full Re)ac6on <br /> I <br /> ManlrestReference Number: <br /> I11b.Alternate Facility(or Generator) U.S.EPAtD Number <br /> e� <br /> FadlitVs Phone: <br /> 18c;Signature oFAftemate Facility tor Generator) Month Dory Year <br /> 4 <br /> 19.Hazardous Waste Ripod Management Medd Codes(i.e codes' r#nazaedoaas waste treabnem,disposal;Eirid magI,ng systems) <br /> 1. 2. 3. 4 <br /> 20.Dasignated'Fadlh Omer or OparMor:Cenifcation of receipt of haienious mataria#s covered by the manifest except as Wed ln1tem.18a <br /> dnted/Typed Name fI Signature path E5-Y75- <br /> EPA <br /> ayYearEPA Form 8700-22(Rev.'3-05)-Previous editions are obsolete. <br /> DIEdII&VATED FAGlLl11PTQ GENERAT6111 <br /> I! <br />