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t)print ku type. Form dosigned for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> U <br /> NIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 701 '1564646 <br /> anffest TrackingNumber TE MANIFEST �� <br /> r�tVame and Mailing Address Generator's Site Address(if different than mailing address) <br /> Iwres "4x -Ilea" <br /> 7 . VJL WJ26415 <br /> Generator's Phone: WAQ �.$"� �$ <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Will l iokt.�tl o +l •n:.:rtT�c;r�r id$r�9g7F 11 tRt' J06174422 <br /> 7.Transporter 2 Company Name U.S.EPA 0 Number <br /> S.Designated Facility Name and Site Address <br /> U.S.EPA ID Number <br /> 27" S, 13" VVIEF " <br /> rum, Am SS <br /> Facility's Phone: n-34la–W <br /> 93. &U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID dumber, 10.Containers 11.Total 12.Unit 11 Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Not, <br /> 1. X=-JK=& t"ard0us MStm Mita#fA (ftJL fttsl WX) - <br /> LU <br /> 1, <br /> rY <br /> L 2. Mk=-9Mp Emmarda" UmMuD Sol-'rte <br /> 3. <br /> 4. <br /> f 14.5 eciaaldn Instructions and Adddli:iional Information <br /> t 3� - oRl. "U M <br /> S2) ii1jl,VViS. XNX 01LIAMONOWM OA.i <br /> AiK—w ``t-' mm; Wear ' w "It. IM HmtAu" temostiMe(400)424—* ft tVONtzmt O�NCrV*743} <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: t 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If eWort shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. ✓`' <br /> I certify that the waste minimization statement identified In 40 CFR 252.27(a)(it I am a large quantity generator)or(b)(if)am a small quanpty generatc;)4s . <br /> Generator'sl0ftero>'s PrintedlTyped Name SMonth Da ignature: Y Year <br /> 1 16.Intemationaf Shipments <br /> � ❑Import to U.S. ❑Export from U.S. Port of entrylexi <br /> z Transporter signature(for exports only): Date leaving .5.: <br /> Liu 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrintedTryped flame Siajnaiure�i Month Day Year <br /> ICL <br /> QTransporter 2 PrinledfFyped Name Signature Month Day Year <br /> a <br /> F <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Re;eclion ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> +moi Facility's Phone' <br /> 18c.Signature ofAltemate Facifily(or Generator) Month Day Year <br /> 19 Hazar&A Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 2 3. 4. <br /> 20 Dssignated FacirityOwner 0r :Ce6fcation of rKelpt of hazardous materials covered by the mamfest excepl as noted in Item 18a <br /> fpmtwyTyw Signature Month Day Year <br /> EPA Form 8700-22(Rev.3.05) previous editions are obsolete GENERATOR'S INITIAL COP' <br />