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42�� <br />Prtease nrint or tvpe.7Forrm6designed for use on elite (12 -pitch) typewriter.) <br />Lnr �i�. " (t II goal <br />1283658 <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. , J DESIGNATED FACILITY 7 DESTINATION STATE (IF REQUIRED) <br />�/ 10912.1524 U <br />UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 1 3. Emergency Response Phone <br />4. Manifest Tracking Number /� <br />00002372 <br />5 DAT <br />WASTE MANIFEST _ <br />5. Generators Name and Mailing Address renprato?s'&fe AddressTif diffeFen-I <br />elailing address) <br />Fedex Freight FEM FREIGHT [STK) <br />6520 SOUTH HIGHVAY 99 FRONTAGE ROAD 4520 SOUTH HIGHVRY 99 FRONTAGE ROAD <br />Gene <br />_ <br />6. Tmn m ny m <br />U.. A ID Number <br />7. er mp a <br />U.S. E A ID umber <br />8.fflat Agg t#M &MjV' <br />U.S q FAR, Rr <br />GENERAL ENVIROKAENTAL HGTr LLC DDR PSC ENVIROMENTRL SERVICES <br />UHITE ROCK ROAD <br />F2454 <br />s hone: <br />19ifi; <br />351 aloe <br />9a. 9b. U.S. DOT Description (ir�Jnxling Proper Shipping Name, Hazard Class, 10 Number, 10. Containers <br />11. Total 10 2. Unit <br />13. Waste Codes <br />HM and Packing Group (if arty)) No. Type <br />Quantity Wt./Vol. <br />Q <br />I. <br />KOK-RCRR HAZARDOUS VRSTE LIQUID <br />f <br />DM <br />v <br />P <br />551 <br />ag <br />do <br />rzu <br />2. <br />NON-RCRA HAZARDOUS VRSTE LIQUID (DETERGENT) <br />561 <br />t <br />Zp <br />3. <br />NON-RCRR HAZARDOUS VRSTE LIQUID (DETERGENT) <br />561 <br />4. <br />NOH-RCRA HAZARDOUS VRSTE LIQUID (OLIVE OIL) <br />331 <br />14. Special Handling InsWctions and Additional Information <br />(1) FEFNO Q-00 - PROR 2190550256 NON (2) FEFINONHRZLiQ-OO - PROt 2110092024 NON (3) <br />NMIQ-88 <br />- PRO# <br />2305951954 NON (4) ZLIQ-OO - PW 2132001624 NON <br />15. GENERATOR'SIOFFEROR'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, <br />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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />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 quanfity generator) ij true. <br />GeneerTato slOfferronrs Pri nteffyped Name Signature A <br />Da Y arc <br />Mao <br />-1 <br />1- <br />16. International Ship is <br />❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: <br />= <br />Transporter signature (for exports only): Date leaving U.S.: <br />w <br />17. TransporterAckno ledgment of Receipt of Materials <br />= <br />Transporter 1 Printedrryped Name natu <br />Day Year <br />O <br />& <br />k- ),I- - -JPKNEO - - - <br />L! I <br />4 <br />- <br />Tr ns rt T1 ' t Signatur <br />Mo Day Ye r <br />Q� <br />18. DisaepaAcy ;.cif~ <br />18a. Discrepanry liid' ' twn Space <br />r ❑ Quantity❑ Type El Residue <br />❑Partial Rejection <br />❑Full Rejection <br />Manifest Reference Number. <br />18b. Ahemate Facility (or Generator) <br />U.S. EPA ID Number <br />J <br />V <br />L6 <br />Facility's Phone: <br />W <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />Q <br />z <br />H19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recycling systems) <br />C <br />1. 2. 3. <br />4. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazaraous materials covered by h manifest except as noted in Item 183 <br />PrintedfT, d Name Signature <br />C <br />Month Day Year <br />1 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. , J DESIGNATED FACILITY 7 DESTINATION STATE (IF REQUIRED) <br />�/ 10912.1524 U <br />