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77 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2030 0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number 7�t � � � � � u WASTE MANIFEST J1, - � JJK 5 Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) IQ Generators Phone ' 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address st ,. a, U.S.EPA ID Number Facility's Phone "� 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 Wtivoi. 1. 3 i O .. E Z 2. i _.. 's 3 i i d 4. 14 Special Handling Instructions and Additional information ) xmmt �.,= 15. GENERATOR'S/OFFEROR'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 labeledfplacxrded,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,1 certify that the contents of this consignment conform'to'the terms of the attached EPAAcknowiedgmenf of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am asmall quantity,generator)is true. Generator sfoff es.Printod/Typed Name Signature Month Day Year u16.International Shipments r- ❑import to U.S. ❑Export from U.S. Port of entrylexit Z :Transporter signature(for exports only): Date leaving U.S.: WW 17 TransporterAcknowledgerent of Receipt of Materials ;r TraosWer 1 Pnnted/Typed Nama Signature f ( Month Day Year G. ° Transporter 2 Pdntedrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy indication Space Quantity ❑Type ❑Residue ❑Partial ReJection ❑Full ReJection Manifest Reference Number._ 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J V &A.. Facility's Phone: 0 18c.Signature of Alternate Facility(or Generator) Month Day Year Q 19.Hazardous Waste Report Management Method Codes(i.e.,codas for hazardous waste treatment,disposal,and recycling systems) G 1, 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdntedrryped Name Signature Month Day Year t EPA Form 8700-22(Rev.3-05) Pevious editions are obsolete. DESIGNATED FACILITY'S COPY