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i <br /> Please print or type.(Form designed for use pie elite(92-pitch)typedatter j '' Form Approved.OMB No.2050.0099 <br /> UNIFORM HAZARDOUS' 1 C br ID Numbei 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST L3fl3,5 �� i1!5$2$8772 01217,24.47 FLE <br /> 5.Generators Name and Mailing Address Generators SbAddress(Wdifferant then mailing address) <br /> liRti?k rii t YOI)W Rift Wloam MA- et"00 <br /> Generator's Phone: <br /> 6.Transporter I Company Name U.S.EPA ID Number <br /> Union pacifio Lytes CO <br /> CefY.1 -y".7,y n. <br /> 7.Transporter 2 Company Name U.S.EPA to Number <br /> .Designated Facility Name and Site Address U.S.EPA ID Number <br /> E Erwiromert d <br /> h i t t West Highway i23 <br /> Facility's Pho r Earn Carbon,La 04520 USA <br /> ga, 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit 13.Warta Codas <br /> HM and Pack ng Group(d any)) No. Type Quantity WLA/ol. <br /> 1. <br /> nr•.A:F1r.r3, rad YAe'Ri'"+.t'".r i:`xRtf CY'1°" t'Yt.r sr+rAt...... t1t'"Y___.:.s.J'. FA <br /> �g A `2' rLr„"! T Yl id DifC4aL`i}�VYY�, t 54N 4t 4r4iik ht? 'i t�tJLtia4lr uj i,#r HG <br /> W <br /> 3, <br /> 4. <br /> 14.Special Hersdling Instructions and Additional Inform tion y ,C <br /> t_1thkg1 RGAI_n6EK1C RE0 F RORCT Liw'�R t f Jci, 1711103-Z <br /> t}ttTs�t�:CRA S;t�ea3der Rg <br /> ECDC promeg M41,ts UN <br /> 15. GENERATOR'S10FFEROR'S,CERTIFICATION!I hereby declare that the contents of this tonslgnment ere fully and accurately described above Wo <br /> by the proper shipping,name,and are ciasd,packaged, <br /> marked and labeladlplaeardad,and ere in all respects in proper amditlon for transport according to applicable k temagamal and national gosamrnentai regulations.If export shipment and i am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAclmovAadgmont of Consent <br /> I certify that the waste minimization statement Identified in 40 CFR M27(a)(If I am a large quantity generator)or(b)(d I am a small quantity generator)is true, <br /> [N9901erorsPrintaciffypaid Name t5ignature lonth Day year <br /> -j 16.International Shipments import to U.S. <br /> ❑Export from U.S. Port of entiylaxit <br /> Z Tran r si tura for uports onl : Date leavi U.S.: <br /> W 17.TransporterA6mowiedgmant of Receipt of Materials <br /> Transporter 1 Printedlryped,,a nature ROM My ear <br /> �R Transporter 2 Nate Iyped Name Signature tMonth Day ar <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residua ❑Partial Rejedion ❑Full Rajadion <br /> Manifest Reference Number: <br /> 18b,Alternate Facif;Ey(or Generator) U.S.EPA ID Number <br /> 'v <br /> W FaaSf,nahue li s Phone: <br /> w 18c. IAltemate,Facility(or Generator) <br /> Month Day Year <br /> 19.Hazardous iWaste Report Management Method Codes(i.e.,codes for hazardous waste freahnent d spasm,and racyd'umgsystems) <br /> UA® 1 2 3. 4. e <br /> 20.Designated Facility ftner or Operator:Certification of recaipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdntedfryped Name Signature <br /> Month y Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete, DESIGNATkb FACILITY TO GENERATOR <br />