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II I II I II I I II I I VIII II Ili 11 IIII IIII III 006339ISK Flease print or type. (Form designed for use on elite (12•pilch) typewriter.) Form Approved. OMB No. 2050-00z9 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page i of 3. E of ency ResRonse Qlionp" 4. Manifest Tracking Number kk$-? : , 006325889 SKS WASTE MANIFEST 5, Generator's Name and Mailing Address Generators Site Address (•d different than mailing address) IJ r A 11 Generators Phone: r`yrrf ' `' I* ` " '0 P 6 Transporter 1 Company Name r ) U.S. EPA ID Number 7. Transporter 2 Company Name U.S. EPA ID Number trTFt ;ir_ ;'r t r- IT} j ' t , t 't +`a •l ? :. ,?. tl ; . il )tfJtj, . . NTI' . J? _ lff . e !f• tS . s. . , , s . . ; .. . : . .. 1•, 8. Designated Facility Name and Site Addressr +l 1. Ct4t "ARKM tiy j ) i iV r . .!. r. U.S. EPA ID Number CIA =: 0 PI kJ 4�X Facility's Phone: ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Tolal 12, Unit 13. Waste Codes HM and Packing Group (•d any)) No. Type Quantity WtNol, r f; , r� ; :7 `?;•'` t�2 t'- j vsf4': •( f:. 1. .. 1 (-'1 ) f. �� f ?ij' r"� � ., KA1 1... 1'1. ;1"I#.. ) - - -- r R cs-- z 2. i� 3. ! t' ! t 41 i h 14. Special Handling Instructions and Additional Information 1 ril.5 t j 3 r : . •; 3 �. �. 1�F. ±, ``t- L1. }:` +( I. { FH 1 GP':. t TFT ) r� U � / (J ✓ ! � Ci r" ; ti - t TO t ' t "q" C ffk •A .- C; r, ... i 15. GENERATOR'SlOFFEROR'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, 1 marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable Intemational and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcimowledgment of Consent. I certify that the wape 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. [+ ;16. nerators! er s ntedlTyp Name Sign Month Day Year J Internaonal Shipments ❑ import to U.S. ❑ Export from U.S. Po f entrylexit: Transporter signature (for exports only): Date leaving U.S.: L 17. TransporterAclmowledgment of Receipt of Materials it Trap po er1 Prints dffy Name , h Signature • .- Month Day Year ' Z TransporteT�n d/Typed Name Signature r Month Day Year rY �;f tee t-_ 18. Discrepancy 18a. Discrepancy Indication Space El quantity El Type ❑ Residuej ❑ j F] Partial Rejection Full Rejection Manifest Reference Number. 18b. Allemate Facility (or Generator) U.S. EPA ID Number .J li Facility's Phone: tL 18c. Signature of Alternate Facility (or Generator) Month Day Year r� .z 4+D 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) LJ 1 . 2. 3. 4. Intl 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a ` t PdntedirTyped Name Signature Month Day Year _ t� l ERR Form 8700-22 (Rev. 3.0, Previous editions are obsole e. DESIGNATED FACT ITY TO DESTINATION STATE (IF REQUIR 1)