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Please print or.type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number p p p/� WASTE MANIFEST G f 0 0 11 sJ NJ UO 5.Generators Name and Mailing Address Generator's SileAddress(if different than mailing address) STGCiI7iJN Generator's Phone; 6.Transporter 1 Company Name U.S.EPA ID Number I 0AD:0282770•;r 7.Transporter 2 Company Name U.S EPAID Number 8.Designated Facility Name and Site Address U.S.EPAID Number Facility's Phone: (<,3313)��+, ,c'Z?��t3 A L R O O O 5 21.1.4 6 1 1 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.,Containers. 11.Total 12.Unit I..I.J HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1 i''dt)Id-RCPA I f/.:, i+ i.OUS WASTE,SOLID.(OIL.Y ABSORBENTS) 952 - 3. 4. c� l - - I . 14.Special Handling Instructions and Additional Information EMERGENCY.CONiAOT:CHEMTREC :L-600424.93W WCA.$TE'RMINAL:CEkGy 06 NAERGfV 981.::171 PROFILE#'4133.:' PA0681-162623NRS OILY ABSORBENTS AP PRIATE PPE EQUIPMENT 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 classified,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 I am a small quantity generator)is true. Generator's/Offerors Printed/Typed Name Signature Month " -Day Year. fit.-,:•f . . .. / r\ :.� 95 - —r 16 Intematiohal Shipmentsd'' r i— ❑.Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials LLJ Transporter 1 Printed/Typed Name Signature Month Day Year r t 103 0.� Q Transporter 2 Printed/Typed Name Si nature r g /,P i , Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Partial Rejection ❑Full Rejection yp ❑Residue Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V LL. Facility's Phone: 180.Signature of Alternate Facility-(or Generator) Month Day Year Q - CA 19.Hazardous Waste.Report Management Method Codes(i.e„codes for hazardousyvaste treatment,disposal,and recycling systems) LU 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/Ty ed Name Signature r Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete; r. . DE GNATED FACILITY TO GENERATOR f