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?lease print or type.{Form designed for use on elite(12-pitch)typewriter.} Form Approved.OMB No.2450-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2=1of mergencyResponse Phone 4,Manlfeat Tracking Number <br /> WASTE MANIFEST lK. [ y 4 59 F L E <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> h6stwea i011 RCS MIF" (Eam UrIlli i� O) <br /> 1700 Nk N*W-k G4 9S37 <br /> Generator's Phone: AF64 awn <br /> 8.Transporter 1 Gornpany Name <br /> ,A�++��...,e.j``�.�,�y ad*ravipw Q�� U.S.EPA ID Number <br /> 7-Transporter 2 Company Name U.S.EPA ID Number , <br /> 8 Designated Facility Name and Site Andress <br /> U.S.EPA Ip Number <br /> r.d Tmabywo <br /> 8133 ECM Bhp NE <br /> 4uer ua, Hu 67147 <br /> Facility's Phone: 50&4W5,720 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 1C Containers 11.Total 12.Unit <br /> and Packing Group{'d any)) No Type Quantity Yvtjvol. 13.Waste Codes <br /> a '-P,Q. UNIZ63,W&WePWoreL�or,dvtu.%teA43 <br /> PGI. T[ u 7 J j p 0001� 0035 F <br /> OU <br /> LU } 34 <br /> LU z. <br /> 0 <br /> s. <br /> r <br /> 14.Special Handling Instructions and Additional Informatlon <br /> k f'f sri Mirrl eR 1TWI dlE AMInt M G ISM0�3 <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby dedare that the Contents of this consignment are fully and accuralely desc bed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplakarded,and are in all respects in proper condition for transport according to applicable intamabonal and national governmental regulations.i export shipmenl and I am the Primary <br /> Exporter,I certify mat the contents of this consignment conform to the temrs of the attached EPAA.dknowledgment of ConsenL <br /> I certify that the waste minimization statement identMed in 40 CFR 262.27{a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Nneraioes/Offeroes PrinteCyped Name ignaturen y f <br /> ..k 1 <br /> � <br /> 16.International Sttipmerrts <br /> Z ❑Import to U.S. ❑Export from U.S, Port of entryfexh: <br /> Transporter si nature(for exports o0 pate leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrintedlTyped Nameignature on y r . <br /> CL <br /> zTransporter 2 PriMedrryped Namergnature ay ear <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity Type ❑Residue ❑Pa tai Refection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b,Ntemate Facility(or Generator) U.S.EPA Ip Number <br /> J_ <br /> U <br /> a <br /> � FaCdi s Phone: <br /> C3 18c.Signature of Alternate Facility for Generator) Month Da Year <br /> a y <br /> Z <br /> 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ' <br /> T <br /> 3- 4. <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted In hem 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />