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V <br /> Please print or type,(Form designed for use on elite(12 pitch)typewriter,) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page i of3.Emergency Response Phone ' 4. an Tracking Number FL <br /> WASTE MANIFEST C`AL.000355717 1 3 xW,8772 <br /> 5.TeneraWs Name and Mailing Address eneralofs Site Address(if different than mailing d sae} <br /> t�t4:5' L WO RFECYCI Aln'Afttril MMOMs <br /> 'K MG 5 E-"1 Darado St, <br /> .Awlktou,GA 9Q06 <br /> Ganaratoes Phone: <br /> . ransporter pang NOMe U.S.EPA ID Number <br /> 7,Transpor—W.. -peny Name U,S.EPA ID Num6a <br /> 8: esi natad FaMity Name andire mss ' U.S.EPA ID Number <br /> ECDC'Einvhmrientg 'ITCMMS2 01 <br /> Favi s Phon ) 1 East Cxbon.Lrt 64"2 USA <br /> 9a. 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12,Unit 13,Waste Codes <br /> HM and Pacidng Group(if any)) No. Type Quantity MJVoi. <br /> 1 <br /> r.D(�Ioni c`OT t°eow t 31 f 6i+ i> a <br /> 2. <br /> 3. <br /> 4, <br /> 14.Spatial Handling Instructions and Additional Informatlodr <br /> t. SEI YCLM PROJECRAILCAR N6, 5 ...4jelof,d <br /> 1 b, GENERATOR'SIOFFMRr$CERTIFICATIOR-I henabydedare that the opirterdeof 116 consiprt cent are krll;and ac xerafAty described above by the proper sisipp rg name,end are. packaged, <br /> marked and labalacllpiacerded;and are in all respects In proper,conditian for transport according to apptiCable Wamatiaral and national goverilrnerdel iegulations,If export shlprnent and 1 am the Primaiy <br /> Exporter,ice"that the contents of this ocnsignmant oordorm td the larms of the abcheil EPAAcknowladpment of Consent <br /> I certify that the waste minimization statement Identified in 4�CFR 282.27(a)V I am a age qtr m*y gsnaratpr)or(b)(If I.am a small.quantity generatar).ls true, <br /> anera oftrvs Printed fTy*Name W9 nawm <br /> Mon y asr <br /> -j 18,IntemaWriai Shipments <br /> Elimport to U.S. Export from U.S. Pod of entrylax;t <br /> I— <br /> Transporter 'nature tore on! Data lea' U.S,: <br /> 17.YransporterAd nowEedgmam N Receipt of Materials <br /> h Transporter i Printadflyped Name Mom Uay ear <br /> r , IS., <br /> Transporter 2ArintedrrypedName 'on n: y Tear <br /> 18.Discrepancy - <br /> I t 9a.Discrepancy Indication Space ®Quantity ❑Type ❑Residue ❑Partial Rej aon ❑Full R'*cbon <br /> M rdest Reference Number,. <br /> 18b,Altemate Facility(or Generator) ., U.S.EPA ID Number <br /> :.r <br /> Fad' sPhono;;,. <br /> w 18c.S gnature of Ariemaie Fadity,(or C*mrdolMontli Day Year <br /> 19.Haiardous Waste Report Management Metidi_Codes_(i.e nodes for hazardous waste Ueelmmnt dspgsat and systems). <br /> Q 12, <br /> 20,Designated Facility Owner or Operator:Certification of recut of hazardous materials covered by the manifest except as noted In Itsm t Be <br /> Printedrryped Namenature �^{ Month D <br /> N Year <br /> EPA Form 8700.22(Rev.3>(15) Previous editions are obsolete, D831GNATE Cil(TY TO GENERATOR <br /> E <br />