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FD' 0 <br /> I <br /> �l <br /> O O <br /> O0 0 C7 <br /> Please pnntw . Form deli ned far use an elite 12 ch 'ter <br /> M ( 7 Genereb ID Ni 1 Page 1 7 E rgrAa KY RwaPn ae R e <br /> UNIFORM NAZARDDUS I "r rY !.'1 q`.,y. •s __ JJJKWASTE MANIFEST ''A I 0(t" 1 ""'-- yGaneetore Nems ens raeuing Aodreea �N,if f1 1)C�iui':IE/N'08 41&taFsMer 1 Coral Name O <br /> w0pt.D nlf IENWOMMCNTAo <br /> 7 Tranepoler 2 Company Name U <br /> s MIX Ciro= C <br /> 8.Desyrnated Faciipy Name slid s4s Address us EPA ID t O <br /> LAIfffr,RUvopr'F pFr'nyt•Rl <br /> 11%F PK,'0810t <br /> tC1ti AM;F t.F:9 GA <br /> Fal s Mh : 09 ' 0 C/) <br /> 9a. 9.U.S.DOT Description(ire)Wing Proper Shrpping Name,Hazard Class.ID Number. 10.Contel 11 Told 12 Uri r a y�CaOr <br /> HM raid Padrgi9 Crorq{a anyliNo Type 10—yA[y ^b 77 <br /> I'in Wt,.. <br /> O 7 <br /> C1 n <br /> c� <br /> D <br /> 4 <br /> 14.Special Handling instructions and Additional information <br /> I <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the propel rte.emu are <br /> marred aid lebeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental ula�ns i <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPAArknowledgmenl of Consent. g elWdrt emit-am te <br /> I certify that the waste minimization statement identified in 40 CFR 211 lift an a large quantity generator or dl am a small uanti <br /> Genefatoes/DRerol pp a.Typed Name l (I( q ty generstorl is flue <br /> Signature wow <br /> J 16.Intemalronalshipments <br /> ilim- ❑Import to U.S. ❑Export from U.S. Por of entrylexit <br /> Transporter signature(for exports nnlyl: <br /> w 17.Transporter Acknowledgment of Receipl of Materials Date leaving U.S.' <br /> Transporter 1 PrintedRyped Name <br /> L Signature Mont. , <br /> w `es <br /> Q ffansporter2PmnledRypadName <br /> HSignature <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑Quanlity ❑Type ❑Residue <br /> C.:PartW Rtllecmt ❑FA f�cran <br /> 18b.Alternate Facility for Generator] Manliest Reference Number <br /> 1 <br /> V <br /> U 5 EPA ID Nallber <br /> aai Facility's phone. <br /> 18c.SignalureofAltemaleFacilitylorGenaratar} <br /> a <br /> z "art <br /> 19 Hazardous Waste Repo t Management Method Codes(i.e.,Codes for hazardous waste treatment,disposal,and r scyding sysromsk (D <br /> a1 2 a DQ <br /> 20,Designated Facility Owner or 0 rator; pt y <br /> ie (ertdkatlon of receipt nl haze dous materials covered b Me marakat ql M tlfak in tem t El = <br /> � Printed/Typad Name � <br /> CD iyneAlro N <br /> fV EPA Form 6700-22 0') {Rev.3.05 P O <br /> revrolls editions are obsolete. O Ul <br /> ° GENERAL'S MnAL COPY m 00 <br /> N <br /> O � <br />