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Please Drint or Woe. (Form desioned for use on elite (12 -Ditch) t0ewriter.) <br />Form Approved, OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. <br />-, - I -.. - . <br />0 <br />GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS <br />1. Generator tD Number f 1 r r 2. Page 1 o€ <br />3. Emer a}'cy Re pgryse P#h#q a <br />M <br />4. ManlfeaE7Yacking Number g¢ <br />0 6, 6 SKS <br />WASTE MANIFEST <br />(� <br />5. Generator's Name and MailingAddress Generators Site Address (if different than mailing address) <br />y'j T) �7 <br />Generator's Phone: <br />6. Tqrksgtqr, J,Cgmpany �arka U.S, EPA ID Number <br />J <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />-31 <br />B. Designated Faellty Name and Site Address CIN U.S, EPA ID Number <br />43110 <br />Facility's Phone: <br />ga. <br />gb. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HIM <br />and Packing Group (ffany)) <br />Quantity <br />VV11JVol. <br />J <br />2. <br />LU <br />3. <br />4. <br />L <br />I <br />I <br />-L <br />14. Speefal Handling Instructions and Additional Information T <br />F4 1 T 7 7 f"? i ""i) <br />IS, <br />P -13r., 4":'21F il�-" I 4-] 'Y -0JF ' <br />(1 -0 0 V, <br />16. GENERATOR'SIOFFEROR'SCERT[FICA71ON: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeledlplafcarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulaflons. ;f export shipment and I am the Primary <br />Exporter, I carlify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br />I cedify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a small quantity generator) is true. <br />Generatc(s/Offerors PrintediTyped Name Signature Month Day Year <br />-j <br />P- <br />16. International Shipments <br />1:1 Import to U.S. El Export from U.S. Port of entfy/ex[t: <br />Transporter signature (for exports only): Date leaving U.S.: <br />LW17. <br />Ll <br />TransporterAcknowledqmenrt of Receipt of Materials <br />Transporter I PrintedfTyped Name Signature Month Day Year <br />0 <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />18, Discrepancy <br />18a. Discrepancy Indication Space El Quantity El Type El Residue 0 Partial R,],,f,,n ❑El Full RJ,,ti,, <br />Manifest Reference Number <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />LL <br />Facility', Ph... <br />0 <br />Lu <br />18c. Signature ofAltemate Facility (or Generator) <br />Month Day Year <br />19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. <br />1 2. T - <br />14. <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item I Be <br />rdnted(T,ped Name Signature Month Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. <br />-, - I -.. - . <br />0 <br />GENERATOR'S INITIAL COPY <br />