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Please print or type.(Form designed for use on elite(12-piich)typewriter.) Farm Approved.OMB No <br /> 1.Generator ID Number <br /> UNIFORb1,HATARDOUS 2.Page t of 3.Emergency Responss Phone 4.Manifeste7f�aac/ljd umber _. <br /> WASTE ildAPllf'EST C',4 ti:W�:;S,Sc'r, 1 cc;.t.:;►1.f ]tra L G$ 2 ryJJK <br /> S.Generator's Name and MaRng Address GenemWs Ufa Address(If different than mating address) <br /> l�I�t�R'P;a,�• <br /> .V.iliJ/a ISA hali4r AL zijUt\ <br /> Generator's Phone '71m- L <br /> 6.Transporter 1 CompanyMeme U.S.EPA liJ Nmanber <br /> Gwrga W.lMY'ine. GA 747F7t8. <br /> Z Transpoder2CompmyName U.S:EPAID NtmmbeY <br /> �{dd . <br /> 8.Deailntete��C �F�R dttC. U.S.EPA ID Muter <br /> WMi;i IMI,CA M7. <br /> Farili s Phone: 13^2 <br /> go ...9b.U.S.bOTbescii ijo :lmduding:l'topOr Shippbmg Name,:kiazard Class,Itl_Number 10.Conw.ras 11:Total 12 t)nt . <br /> HM and Packing Greup.(ffany)) 13.Waste Codes <br /> Ype UM <br /> No. T Ouartbty W <br /> K fdAltt f;6pElt1S''JY/k��,"f>»'IOti1tJ'f�st ► t!ftietltt <br /> n' - . . <br /> 2. <br /> y; <br /> 3. <br /> 4. tt <br /> 1 <br /> H LAITY I �1�96t aAcn' <br /> 14:Specter Handling Inskwdons and Addilanal lnrwnaWn <br /> ERG 017t 8+!?�QlCE7f a(��, { €�f�r7lPtt <br /> OMAR GIa4r� 1313 PU3- T <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION.I hereby dedare that the contents of tills wnsignment are fully and accamrelefy described above by the proper sfdpping name,as are dass'iied,padmag®d, <br /> marked and lebefedfpiacarded,and are in all respects In proper cmdrJDn for transport aom tg to applicable fntemaUdrraland national govemmenta!regulations.If export shipment amd I am the Primary <br /> Exporter,I ce*.ftt the contents of this wnMjnmerd conform to the terms of the attached EPAAckmowtedgment of Consent <br /> t cert(ty that the waste minimization stdamem idenlbd'm 40 CFR 262.27(a)(d i am a targe quantlty goneretor)or(b)(ffl em asr W quuft generator)b true. <br /> Generatd Sign ! Month Day Year <br /> 9j Vq <br /> —r 18:interna nal shipments <br /> Import to U.S. ❑Export from U.S. ' Partof enure* <br /> Transporter skjmfte(for exports only}: Date leaving U.S.: <br /> 17.TraaapOrterAdmowiedgment of Receipt of Matedafs <br /> Q <br /> T e Signatu a Month Day . Year <br /> C49 r-6 —W.Transparter2 . <br /> S�nalure Mwih Day Tear <br /> t— <br /> I&Discrepancy <br /> 18L Discrepancy Indication Space 0 Quantity ❑Type 0 Residue <br /> ®PMet Rejection ❑FuU Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate fadlity(or Generator) U.S.EPA ID Number <br /> Faculty's Phone: <br /> 18c.SignalureofAitemateFadity-orGenerstor} Montl► Dey Year <br /> P_ <br /> 19.Hazardous Waele Report Manegememrt t8atted Codes(Le,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ( 1. 2 3. 4- <br /> e 20.Designated FadGty Owner or Operator:Cer6ficafion of receipt of hazardous materials wvered by the manifest except as noted fe Uem 18a Y <br /> t ignalure Day J <br /> A'A Form 8700-22(Rev.3.05) Previous Wffons alb obsolete. - <br /> —-----— TRANSP&TER'S COPY <br />