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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 14, Manifest Tracking Number pp WASTE MANIFEST r 7 ! (y i<�'' v tit rr) y r zr 00 ` ( tail i''• t„r t DAT S. Generators Name and Mailing Address1 IN jatj t ) I : f-};5r�;_: Generator's Site Address (if different than melting address) rc r0niYtIf : dtctOi13 d-iei ' r I1115jI ;;r.,; - ! Generator's Phone: t11ry�0- `1f" Y._ 44UG 6. Transporter 1 Company Name U.S. EPA ID Number t - Frrt4aat f TF.IPI {� _. . .- . !-; r , C C.ti::fit POtie2n 1797 e1 7. Transporter 2 Company Name U.S. EPA ID Number B. Designated Facility Name and Site Address U.S. EPA ID Number C t l liC h -IfQTut�. LLG I IG'..: I I( YI NNq'Ai � t f„ Fi0 ' 'I J T C ` 1 ITS' i ` f�m'!ItY :\FSi,"±, 1.111 (;hrf7(:} Facility's Phone: 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13, Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt Nal. o Y w tniflt �rit�.f- .1iF3iL '' 11 ) % it t .; T 3 rs � l �7U7 I i 4. 14. Special Handling Instructions and Additional Information C umefTt E7h . 1BSclrsrl r. ; ft? c°4 if .G'�`2 ) t I�,-,TFF � .: LkI it� r C :�if . .- ,r'flr. �, 12 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of Nis consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, 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 Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I codify 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 quantity generator) is We. Generatotsl0fierm's Printedrfyped Name Signature Month Day Year - 16. International Shipments F ❑ Import to U.S. ❑ Export from U.S. Port of entrytexit: Transporter signature (for exports only): Date leaving U.S.: w 17. Transpoder Acknowledgment of Receipt of Materials � Transporter PrintedlTyped Naml" / ` Signatu[ - Month Day Year Z Transporter 2 Printedrryped Name Signal Month $Day Year 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑Type 1:1 Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181b. Alternate Facility (or Generator) U.S. EPA ID Number U LL Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) - I . 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item lea Printedflyped Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY