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Dec , 27 . 2019 MOW No , 14 $ 7 K 16
<br /> Please print or typo, Form Approved, OMR k'2050-0030
<br /> UNIFORM HAZARDOUS1. Gsnerato/1D Number r 2, Par 1 of 3. Emergency Response Phone d. ManliegtTracking Number �''+ p
<br /> WASTE MANIFEST („ ,, ' ' 7"'; ( . Sr..�r� ;.tr 1 ,`� �,.,f III I: � ,y t J } f�' �►. Q l� L7F
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<br /> 6.Generalet'p Name and Mailfeg Address Generatoft Bile Addresa (11 dif terentlhan matltng addreaall
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<br /> ,a ranapoderiGompanyName i'rtrlopo dick- a EirrY) t'�t»tA t�a1 :3 rv3Pq ;, I,),fa U.S. EPA lb Number pAElf}f±�i;i�ir 1
<br /> 7, Transporter 2 Comparry Name U.3. EPA ID Number
<br /> B. Designated FadlltyName and SiteAddrasa QS Lt"aaoy P)N, lI ! VS. EPA ID Number
<br /> PO 804 4�`(i; 134wy OA i Mi 0'i 9ollV 9rU1 Gt)1 Af,1r,'rt1
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<br /> Fedlitya Phone;
<br /> ya, 99b. U.S. DOT Dowp6on (Including Proper Shlppmg Name, hazard Claas, ID Number, 10. Containers 11. Total 12, Unit 18. Walla Codas
<br /> Nt3 sod Packing Group (If any)) No; J1pe pdanlity • WtNo1.
<br /> 12� 1. plateR041% '•IrM1rl 6kj% l 4xzRrA, utAid (Oily D':djbli;+) t?; 4IV
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<br /> 14. Spin ild ,llrrfudiTaandgd;gktoflalInformaUon
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<br /> GENERATORISIDFFAOR'$ CERTIFICATION; I hereby dedare that (he contents of lhrs consignment are fully and accurately described above by the propershlpping name, art are dassl8ed, packaged•
<br /> marked and Iebeledrplacarded, and are In all respeds In proper condition ror transport scrag to applicable International and natlonal govemmental regulstions. If expdd shipment and I am the Primary
<br /> Exporter, I corny Ural the contents of this consignment conform to the Iemra or the attached EPAAdmowiedgmentofConsent.
<br /> I certify that the waste mfnimaation statement ldenlified In 40 CPR 20227(a) (if I am a large quantity generator) or (b) OII am a small quantity generator) Is trua4
<br /> eneratorsiDrotsPrinted/TypedName ,,3lgnlure ., r Month Day.I% 1 61 , • AYeai
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<br /> J IVIntemallonal Shipments t t .•.f M ,.,...
<br /> n Import to U.S. ❑ Export from U,S. Port or entryrexil; "
<br /> Treasporleralgnalure (for exports only): Dale leaving U.S P:
<br /> 17. TronspoderAcknowladgmenlotReWptofMated2ils ! :0
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<br /> Trans6 rter 1iPrinlad/ryped Name SID \ \ +s' Month DayYear
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<br /> Transporter 2Pdnte ypedNeme signature ° Month Day Year °
<br /> ill. Discrepancy
<br /> 1N. Dlacropaney Indloalioh Space
<br /> Q Quantity [] Type El Residue ❑ Partial fteJecUon ❑ FuIlRejaction
<br /> Manifest Reference Numbef:
<br /> 18b. Alternals Facllq (or Generator) u.S. EPAID Number
<br /> w ✓=ad6tya Phone: ="
<br /> LOU 18c, 8•ignetureofAllemataFacatly (or Generator) Menih Day Year
<br /> 10. Hazardous Waste Report Management Method Codes p,e., codes for h&ardwrsveaste treatment disposal, and recycling systems)
<br /> C3 1• 2. 3. 91
<br /> . 20. Designated Faclilg (g Operator: Certification of recelplof hazardous materiels covered by [he manifest except sanded in Item 10a
<br /> in(edtfyp d 2 Signature Manth , Day Year
<br /> EPA Form 8700.22 (Rev. 12-17) Previous editions are obsolete, GENERATOR'S INITIAL COPY
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