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Pease print or type.(Form designed for use on elite(12-pitch)typewriter.} Form Approved.OMBNo.2050-0039 UNIFORM HAZARDOUS 9.Generator IQ Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 14 10 s' ( r� 5.Generator's Name and Mailing Address;i; Generators Site Address(if differentY than mailing address)„�L�1��• T6�4'��9 t I�kkta�' GA 96316 Generators Phone: 4Pa !S � 6,Transporter 1 Company Name �;iNMENTAL ECCE U.S.EPA It]Number f• 7.Trans��t�e CtT;d�fpFame �3ivNREOsi3VFRf SYSTEM INC. U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number S HiGH� We AY 96 Facility's Phone: i sag} ,. R? AI R0 0O5211 46 ya 9b.U.S DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type .Quantity Wt.Nol. l-tAWDOU S MWE. 5OUD(OILY }I.Wj } O' 352 z 2. w C9 3. ! 4. ) I 14,Special Handling Instructions and Additional information —T� E E £aENt;Y G0#4TF+C ' iEL C 14W-424-9300 WOES TIEMWi CFPFI,;CS lAM#981 ' 3.71. *PPCWIL ' N 1 ' lk26231 RA139 MY SOUDS APPROPM F PPE EOUIPMENT 15, GENERATOR'SIOFFEROR'5 CERTIFICATION: I hereby declare that the contents of this consignment are fully and aecuratefy described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according tc applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. i oertify that the waste minimization statement identified in 40 CFR 262.27(a)(f I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generatorsl0fferces PrintedlTyped Name Signature Month Day Year j 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature{for exports only): — Date leaving U.S.: LW 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedfTyped Name Signature Month Day Year Vi 2t Transporter 2 PrinledfTyped Name Signature Month Day Year IF- 16,Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number {y raQ Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year a z 18.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY