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ii <br /> fir• <br /> 3 <br /> Please print or type.(Form designed for use on elitet(12-pitch)typewriter.) Form Approved.OMNo.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manfw Tracking Number <br /> WASTE MANIFEST r� ,L <br /> i"'.rel 6!t41 lr`i.�s7 f 7 1 77 <br /> 5: vera os s Name and Mailing Address nerators ita Address(f d ff�rent than malting address)~ <br /> I_ ,'4AL SVC RECYGLING AmxMillam Wadofica <br /> aC€rttt€t,C�, <br /> Generator's Phone!` <br /> 6.Transporterl .. pant' ,me U.S:EPAIDNumber <br /> 7.Transptuter 2 Company Name, .;,' U.S:EPA ID Number <br /> 8:Designated Fadlity Nama and ite Address U:S,EPA ID NumberEC, .. <br /> Dl,'EnviroranenliI 11T fICiU ;T'cfsc T. <br /> I f i 9 West Highvmv 923 <br /> Fad(' s Pho& 444-4.459 +last G'arbon,IJi 8452D USA <br /> 9a. 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Container 11.Total 12,Unit 13.Waste Comes <br /> HM and PaddngGroup(dany)) No. Type Quantity WtNoL <br /> fa'� 4t^a A P`(".'Y`.,« 3_.n� m P}y� 1�X adT <br /> t r r-r. r .#�u•,t di� l v aifil 11 <br /> 'c, �F C I i'6104-L O t t"Wul,alc-dj tom: J <br /> 2. a <br /> LU0 <br /> 3. <br /> 4. . <br /> 14.We]Harding Instrudionsand Additional Information <br /> ��•`r�uPf�C3.fEGT' <br /> flc>xfi GRA..S � r R <br /> 15. GENERATOR'SIOFFEROR'S,CERTIFiCATION; I hereby dedarm tl�t the cot tents of this consghment are.fu�y and Y described above by the peeper shippktg'name,and are classified,packaged, <br /> I marked and Iabalediplacarded;and are in a8 `" <br /> respect in Proper con for tran, ,accotdh g to apgllcab a ettamational and national game mental regulatkms.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the tarns ottl attachad sopa <br /> of Consent. <br /> I certify that the waste m nirnFestion statement identified 6i 40 CFR 20-'Z (d Tarn a large quantity gerreramr)or(b)(M.(am a small quantity germtor is hue. <br /> aratatst e s PdnteVyped Name briinaturm Month Day Year <br /> -j 16,international Shipments <br /> ❑Import to U.S. ❑Expod from U.S. Part of ent yi t <br /> TmU2Lxter slanature for As OnN): Date leaAng U.S.: <br /> E 17.TransporterAcknorAr figment of Recelpt of Materials <br /> Transporferl yped meSignature month Day ear <br /> i O t 1, x 5 i <br /> , <br /> m Transporter 2 PringFyped Name n re <br /> ear <br /> 18.Discrepancy <br /> 18a.a'screPancy indkatan Space D Quantity DTypa ❑Residue ❑Partial Refodon ❑Full Re)ection <br /> Menifesi Rafaranoe Number: <br /> . 18b:Aitemate Fact ty(or Genitor) U.S:EPA ID.Numbar <br /> Q <br /> u R± s Phone.: <br /> 18c:SlatureofArtefnata.fadfiry(orGenera#or} <br /> Day:: Year <br /> 79 Hazardous Waste Report Matagerriepj tl a> star tiaiardous viaste treabnant dJ pnsai,and rerjridhig systems} , <br /> 13. <br /> 20.Designated Fachtty t?vre er o OperaioF mateliais.coverod by the manliest except as noted in Item 18a <br /> r`nrR ffyped Nama <br /> _iSignature Monlh ay Year <br /> EPA Form 8700.22(Rev.3-05) Preva�Us sotetsr DES0 ATED FACILITY TO GENERATOR <br />, <br />