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V <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0038 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone 4. an it Trac Num r <br /> WASTE MANIFEST CALOM557 17 1 $ 3 8772 011 3870 FLE_ <br /> T. eneratoes Name and Mailing Address Generators Site Address(ff different than masing sadmaTs <br /> 1:3 L SVC FUYCtJNr, A1ft WMM tadofrd=j <br /> 320 S El L)M*.St, <br /> o0loN1,GA MW <br /> Generator's Phone: <br /> Transporter I Company Name Us: AID Number <br /> 7.Transportar'2 <br /> try Name. U.S.EPA ID Numir ' , <br /> Designated Facility Nemi a rasa' Us:EPA ID Number 'r <br /> Facilh esPho Q 1Eat„ V t n.4 ?S ALU <br /> ga, gb,U,S.DDT Desciptiort(Including Proper Shipping Name,Hazard Class,10 Number, 10 Conteinera 11.Towl 12,UM 13,Waste <br /> Coda <br /> HM and Paeldng Group of any)) No, Typa Quantity W1Nol: <br /> 1 <br /> t4 N- O to`r-) WOM;WASTE,SOW;. T J iii HG ���:� T <br /> 2 iq.�j.' ... it�•4. ..,.E t 't:lf'l <br /> 3. <br /> 4, <br /> . <br /> 14.spadal.Her ;j Inabuc6one_ ., I C J <br /> 15. GENERMTOR'=F>:EERQR`S CEnFICATfON:I hereby decta�a prat the eta dU><a .. @ro tuRy did ecairatdy dasiri6ed aii4rofiy Hca prefer ahtppk�g name end ars <br /> mar9cad and label and are In atf hprow1abitdiNonta.vanYport axail%j appiicabte 1MeRm8onat grid natlarsal' regufatlons:If export ahlpmettt aietl9 am ft Primary <br /> Exporter,I'caNfy that the ocxdenb of this eansfghmarrt conform to the farms of the aeadsed EPAAclmaMedprnentpf Corti nt <br /> i. #sat ftre waste minNn anon atanant lderttiBed hr40 CFR 24.27(a)V I am a large quantity generator}of(b}(N i am a lamas quantity )is true. <br /> era t s n maw2newremoran ay or <br /> r 18.Intemat onel Shipment ®Import b U.s.` ❑Expod fmm'U,S. Port of"b*d, <br /> , T <br /> Transporter snature fora rts Data!a U.S.: <br /> 11.TransportarAdwMadgr*M of Rwolpt of MaWeIs <br /> ransporter t ratted yped, .tree re on Year <br /> ransporW2 PrintedlTyped Nam$ tivriature -7- Month Day ear <br /> I <br /> 18.0twepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Peru Raw. ❑RA Raloction <br /> i <br /> fdaisitas!Refarenoe Numtser: <br /> t8b.Alternate Faddy(or Generate U.S.EPA ID Number <br /> tj <br /> Ll <br /> 18c: gnature•ofAltemata FaaRty{oi tor) Ue ay Year <br /> 19,liazerdaisWaste Rapat,Mar�gamarit Mathpd Codas(I.a..cadaa for.hardouswalla traairiti®r t dispcasi,god raoycdlrsg;syatams); <br /> ® 1. 2 4: <br /> 26.Dasipnated Facility Owner or Operate:Caftst on of r cco of hazardous matttlats eoVered by the manifest except es rated in bin 18s <br /> Printadrlyped Name } nature �' year <br /> EPA Form 8700.22(Rev,3.05) Previous editions are obsolete. <br /> DESiGNATEVIFACILITY 70 GENERATOR <br /> f <br /> I <br />