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Please print or type.(Form designed for use on elite(12-p'rtoh)typewriter.) Form Approved.OMB No.205D-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.klanffestTracking Number <br /> WASTE MANIFEST A 3 t ar S: { 4 114 :;�<:a;,=1_t ,�_ � <br /> 007748-.51.- <br /> . JJ <br /> 5.Generator's Name and Mailing Address Genera NeWdrdss(d different than mailing address) <br /> LA .a' <br /> �r>l ��'! <br /> Generators Phoria::. ;.i a:t _ t. ;�.a H `;r:_ xs•rc,:,k: siie 1 .��+r'... x3'os <br /> 1'.. ._...—.j!,..... - rrtli,� . i:Uii;•=:r:a rr.. xa <br /> 6.Transporter 1 Company Name ar .5.11",5;in E;x _:.:.r; 'a I SXI€FftJf3Nuinbetm aar,arnsrrq:na <br /> !!!1'19.i:'S!i 4E c=,-i: ar rzyrl;.^.�.0: {t.,1'. n rt'u--6', ` <br /> �_. .i _ .�;.':�• iv _ Fk.,YiL..�t�i<`�11. 7`l:rr.•..r at..•en'S�r•.r .-�natw m'd+r.AY TA• ��t t saiTaea?:v� <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated•Fadrdy Name and Site Address '`s"' U_S.EPA lD Number <br /> . ...,....._. .:..t t. .._ .:'i=-• -��',a�':. .rt...`r:i�:..inS!7';at)31W0 LA• .1i mn <br /> • .-t. ':r•_••:.-., .....:.''!}9F1s' s,•.'.,�,JV i�a�.GrZSVi Srv�lnL 9�,'tu'10a�sit G 5=SS6n drlr let^�'• <br /> FacilitysFharer �._ �.�•' x;Z-_ <br /> ga. 9b.U.S.DOT Description(including Roper Shing Name,Hazare ctass,ID Number, . <br /> and Padding Group of any)) ' ``" ES i t�ltJ&�' <br /> HM No. T•Jpe Quantity WtNal. 1Waste Godes <br /> D 5??sN='ry or,P�6 P 2 Su^,Bit'*art& Bill 191n9.sio* <br /> p `'f eG.srd :!rn 8 xd lot tibil:rn Nt nc <br /> � ...._..- _......:.w..�.__. ._. .._ -°,��. _. _. ..%.E+,;is u-••_'i*a`ci`- � ;u�'. �y;r-=. � r �r <br /> 2' zsl 9 Oi 2 i':ii.^ !1 E5=9ti:'' 2i8 tS. dhoci ;:. - i t <br /> r1 % 'k{it$ SenAJrn' <br /> LU <br /> 3. <br /> 0146p,edal Handling Instructions and Addik-nal information r <br /> ...... .._ .. .-,t;5Co. $f�lj.Ct-14,tr:r <br /> I5. GENERATOWS10FFEROR'S CtRTIMCATION:I hereby declare tJ';A the Contents of this consignment are idly and acctrrat*described iii!'we,by the proper snlpping;rtwne,and are classified,padded• <br /> marked and labekWplacarded,and are in all respects in proper cDnd::Inrr for trartsport according to applicable international and nkiffial gove amentafregulations.If WPA shipment and I am the Pty <br /> Expoller,I certify that the contents of this consignment conform to the terms of the attached EPAAckrwwledgment of.Coraent <br /> I certify that Bre waste minimization statement kWitifutil in 40 CFR 2e t27(a)(If 1 am a large quantity genera)or(b)(if I am a.smal6r ur:�+it•rya i e. <br /> Generator'slOffaror` I'r! yped Name) Signature A r Moan. Day Year <br /> is s f fes.. 4--•"^.. <br /> a (lAnternationarShipments FJ ' <br /> j.. lnixrt to U.S. ❑Export frau U.S. Fort of enhyJexit <br /> Transporter signature(for exports only): Data(oavvmy.U.S.: <br /> LU <br /> '17.Transporter AcknowtedgmentofReceipt cfMatenals <br /> Yrenspotecl Pdntedffyped Name Signature Month Day Year <br /> rens__' <br /> Tran porter2-Prinledffyped larrre S(gnahire, ^^ '" Mont Day' Year <br /> 18.Disompamy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pgrtial'Rejection ❑Full Rrilac:Bon <br /> Marrilm Ref erenre Number. <br /> 18b.Alternate facility(or Generator) U.S.EPA ID Number <br /> U <br /> ra► Fadktys-Phone: <br /> 18a SignattrretifAltemate facility(or Gen"k4 Month Day Year <br /> Q ' <br /> z _ _ <br /> 19.Hazardous Weste Report Management Method Codes(.e.,codes for imitardous waste treatment,disposal,and recycling systems) V <br /> Q 1. 3. 4. <br /> 11 <br /> 20.Designated Facility Owner of Operator.Certiilice ion of receipt of i 1ws materials covered by Ute manifest except as tided In Item 18a� <br /> PdnWwyped Name Signalure •, Month. Day Year <br /> d-J� <br /> COPY <br /> EPA Form 8700-22(Rev.3-055) Previous batt T1s are obsolete. __ TRANSP&MR' <br />