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C7 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 i of 3. Emergency Response Phone 4 M }n f st Tracking Number WASTE MANIFEST CIII Is/ r I f i Gr C! 'i r ;C1 t { U r- i ��- JJ 6. Generator's Name and Mailing Address / T 1 C,ra u i , Grass ote Site Address ( f different than mailing address) Il to „ir , i7ti C ir.` • t 'tt7 , he': 119 FIF yg Generators Phone: slJ, -t- t 6. Transporter 1 Company Name :,' , „ _ U.S. EPAID Number , r`1 011 P, kr t T- t E.3., T.Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number iIT�i - - Facility'sPhone: /. .="- 7 1 Cj- 4 '; `s ga. 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.Nol. i , _ .. i .i r. l I 0 it 31 a 4 it- it 14. Special Handling Instructions and Additional Information `l: . t' _li_5 iter f lr ,-fTr; r 11-1: " i ,n : "t1 1 i r . 31- , . I ” N ee k F r ct L N; �4 I ( '2 10" t L � 1 ' . l0 t ' 15. i GENERATOP.'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, marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and l am the Primary Exporter, l cert that the contents of this consignment conform to the terms of the attached EPA Acknowledgment or Consent. I caddy 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 true. Genoa o 'slOHeror's Pnnledlryped Name Signature Month Day Year 16.E International Shipments r ❑ Import to U.S. ❑ Export from U.S. Port of entrylexil: Z Transporter signature (for exports only): Date leaving U.S.: 17, Transporter Acknowledgment of Receipt of Materials Tranpolteci. Printedryped Name r, _Signator, ;;,., Month Day Year QTransporter 2 Printedflyped Name Signature Month Day Year - - rr h 18. Discrepancy �. 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 186, Alternate Facility (or Generator) U.S. EPA ID Number '.,. J U LL Furtive Phone: j 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. 20. Designated Fadlity Owner or Operator Ced (cation of receipt of hazardous materials covered by the manifest except as Asked in Item I 8 Printed/Typed Name Signature Month Day Year 1 I EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY f