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Please print:or type.(Form designed for use on elit6(12-pllch)typewriter.) FGaner AZARDOUS 1.Generator ID Number Form Approved,OMB No,2050.00;E 2.Page 1 of 3. me egcyaspo se.fone 4.Manlfest Tracking Number ANIFEST >° f tx ,., ., : ; i : �+ p Nama and Malin Address (, la B TSL A 1 E Sa a ' w Generator's SI a Add ess ..r'. a�a.(ifEdlffe�e4(tltar�rr�all)fn address} V q7� F�ee�a�.1k .'i NO 16-Tran Generator's Phone:? an�€am �6.Transporter 1 Company Name KR. T U S EPA ID Number 7.Transporter 2 Company Name �� , 0.6 a` " U.S,EPA ID Number 8 Resign 1edFacilffy�IVar�eandSileAddress w . U,S.EPA {{ IDNumber IFactlily's Phone: a ga, 9b.U.S.DOT Description(mcludmg Proper 9hlpping Name,Hazard class;ID Number, #0,Containers HM and Packing Group(if any)} 11,Total 12,Unit 13.Waste Codas 1 No, Type Quantity WL/Vol. Z 2. to C7 3. i a 4, x 14,Special Handling Instructions andAdditional Injfo"rmation g YE T 15, GENE RATOR'SIOFFEROR'S CERTIFICATION; f hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are l am the Primary classIfed,packaged, marked and labeledlplacarded,and are In all respects In proper condition for transport according to applicable Inlernallonoland national govern Exporter;I certify that the contents of this consignment confom to the terms of the attached EPAAcknawledgmant of Consent, mental regutailons.If export shipment and I certify that the waste mfnlmization statement identified in 40 CFR 262,27(a)(if I am a large quantity generalor)or(b)(if I am a small quantity generators two. Generator Wfferor s PrinledlTypa-Name Signature Month Day Y 18,Inlem it onal Shipments ❑impart to U.S. ❑Export from U,S, Port aT enlrylexiL Transporterslgnature[icrexporisonly); U05 17.TransporterAcknowladgment of Recofpl oFMaterials Dale leaving U,S,: Transporter 1 Printadfiy�ed Name Signature Month Day Year - v� Q Transporter 2 Printedlfyped Name � Signature �, =� } Month Day Year l 18.Discrepancy r' 18a,Discrepancy Indlcalion Space ❑ E Quantity ❑Type ❑Residue • ❑Partial Rejection ❑Full Rejection.;! i I8b.Alternate Facll{ty(or Generator) Manlfest Reference Number. � U.S.EPA 10 Number V U Facilfty's Phone; LOU 18c,Signature of Alta Facility(or Generator) ¢ Month Day Yea 4 '1g.Hazardous Waste Ropdrt Management Method Codes(i,e„codas for hazardous waste treatment,disposal,and recycling sy5lems) 2. 4. 26.Designated Facility Owner or Operator:Certification orracetpl of hazardous materials covered by the manifest except as noted In Item 188 iprintedffyped Name ' # r r. Molnth Day Year- EPA'Form 8700.22(ReV:3.05) Previous editions are obsolete, r. f", ! 1.�;