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Piease print r rm designed for use on elite(12 pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIF RM HAZARDOUS 1.Generator ID Number /; 2.Page 9 of 3.Emergency`p Response Phone 14.Manifest Tracking Number WASTE MANIFEST ! i- .:). .Z..�• 5.Gene is Name anal Ing Addreps Generator's Site Address(ff different than mailing address) `7 f L�L -17 ,cr.�v Generators Phone:r,)014 `iSY '17's 1 6.Tragi porter 1•Company Name U.S.EPA ID Number ifF� LE')l� G'a'aJ110rfr(_t G�r�_ i�'I� ! ► �' a�. c�vU 3'l!✓ v ' 7.Transporter 2 Company Name U.S.EPA ID Number r r A)V mUEFi'-f'�I/lt r t l�f ttt.r1% CItx 'q L-10j 1 S at 8.Designated Facility Name and Site Address U.S.EPA ID Number "V'7 320 010 OW Facility's Phone: d I,a 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt./Vol. 0lfalilrCLjttl W 9 i I Z 2. 3. s t 4. I r 14.Special Handling Instructions and Additional Information CF. Li r (%r'7/rd (!��.. . ' '.r>� '?i. .pt('/�C..�. 15. GENERATOR'S/OFFEROR'S CERTIFICATION:i hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classed,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if[.am a.small qua.itity,generator)is true. Generator's/Otfferor's Printedlryped Nae Signature t Month Day Year A. Ir tefr� J 16.Intemational Shipmentst Port of entry/exit t: f... � .❑import to U.S. El Export from U.S. �...„ �, ry/exi Z Transporter signature(for exports only): Date leaving U.S.: s W 17.TransporterAcknowledgment of Receipt of Materials /� 1i Transporter 1 P'nted(rype f�t Name �r� {/ Signatufe e�J � f Month Day Year oh' i gt r IL Z Transporter 2 Printed/Typed Name ` Signature f Month Day Year 18.Discrepancy � 18a.Discrepancy Indication Space ElQuantity ElType ElResidue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U ua. Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z V519.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. W � 1� 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of recei t of hazardous materials covered by the manifest except as noted in Item 18a Printedrlyped Name Signature / k Month Da Year EPA Form 8700-22(Rev.3tS5)Previous editions are obsolete. %'I DESIGNATED FACILITY TO GENERATOR i./