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Fiease riot or t(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OM8•tVo.2050 <br /> UNIFORM HAZARDOUS 1.Generator ID Numlrer 2.Page 1 of 3:E—ka*ncy.Response Phone 14.Manifest Traciting Number <br /> WASTt2 MANIFEST t:t!l. ' ° :i: f 20 3etd. 1 �JJ. <br /> S.Generetet's Nameand Mla4kgAddress Genere.toes SiteAddresss(If-di tthan malting address) <br /> SnJF.nhI'°.yy6t�f!/E,,/C�`,+�44��•.�. i1ryfr.•6. Vl+{w <br /> Pp.�y�.le.�4..��Ua���w•.p�N�t=nyy{+�4�,hY�rsi7.`` ?I7:.`�u�+41�i�. <br /> s7,.T CKT13N CA.SM . <br /> Gehmatoes.Phone: _:`• •s[T1d: <br /> 6.Transporter tiComp"any Name`: <br /> U.S.EPAID Nufter. <br /> - <br /> ` <br /> 7:Tran' <br /> .spDrier ny 2 CompaName <br /> �. U.S.EPA ID Number <br /> 8. ated'Fa Naimamt Site Address U.S.EPA ID Number <br /> ILD 171ANSFL <br /> 16Z E OL010# 1!Ln <br /> -- _ <br /> .Fad :Phond:r;'" <br /> 9a -96U:$'DDTQWft&WdLdngPmperShipping NwaHazard Class,IDNumber, 10..Contahere •V <br /> ahs Paddrig G. <br /> (O any)) 11.Total .. 12 Unit 13.Waste Codes <br /> No. lye Quantity WLAIW. <br /> if 1' ",{!1isF Eft)2 A t�LZ!�R 14.1 '>♦i TE SOLID(olly a'Ve.4berltl f31vt P <br /> w <br /> c`ZE(01 <br /> 3. Yi FE B I W2016] <br /> 1?.. <br /> 4. g ryg.pq r <br /> .C. !Y'h'. 1� .f' <br /> 14.Special Handling Instructions and-Additional,Information <br /> eRG#1?1 . !?fira�€t,M# :. <br /> WEAR G-tw;i.I:- ca �3t3—v3r ' <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare Oil the contents of Oris consignment are fuQy5M aodmety described above by Ore proper shipping name,aryl ara classified,packaged, <br /> m!aked and fabetedlptacarded,and are i n all respects In proper condition for transport according to applicable International and national gavemmental regdadans.If export shipment and I am the Primary. <br /> Exporter.I cw*that the contents of this consignment conform to the terms of the attached EPAAc1unmv dgmWof Cwnaent. <br /> I cm*that the waste aftrnizaOan statement Identified in 40 CFR 282.27(a)(If I am a targe quantity generator) ,(b)(ifl am a smatquar*generator)Is true. <br /> Generator'slOfferonts Name f SIg r Mgn1h Day fear <br /> F 16.International Shittts n ( r <br /> ❑import to U.S. D Exportfrom U.S. Port of enbylew't <br /> Z 71ansponer signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Adu awledgmend of Receipt of Materials <br /> Trensprt3S"f Signabue r "' Month Day r <br /> fSZi Transpoder2PrintedfTypedNam Signature - - Mantic Day Y <br /> ep <br /> OCR •'�" <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space on* ❑Type Q Residue ❑Partial F*d, ED Full Rejection <br /> t86.Alternate Facility(or Generator) Manifest Reference Number. <br /> ) U.S.EPA ID Number <br /> V ' <br /> ua. Fawws Phone: <br /> t8c.Signature dAitemateFacility,(or Generate* MonOr Day Year <br /> Q <br /> z <br /> w19.Hazardous Weste.Report Management Method Codes Q.e.,codes for hazardous waste treatment,disposal,acrd recycling systems) <br /> O 1. I Ll <br /> � T <br /> 3• 4. <br /> 20.Designated Facility Owner or Operator.Cerb'fiation of receipt of hazardous materials covered by the manifest except as rioted in hem tea <br /> rintedffyped Name ) <br /> r Month Day �Yeap <br /> EPA Form 0700.22(Rev.3-05) Previous editions are obsolete. TR NSPORTER'S COPY <br />