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Please print or type.(Form designer)for use on elite(12-pitch}typewriter.) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS It.Generator lDNumber • 2.Page I of 3._Erpp(ge ­14.—Manifest Tracki nP.Number pcy�,esppnse P*Q <br /> WASTE MANIFEST <br /> 5.Generator Noma and MarlingAddress SKS- <br /> Gererator's Site Address(if different than mamrig address) <br /> Gerperalor's Phone: <br /> RECEIVED FES 2 7 2018 <br /> U.S.EPA 10 Number <br /> X" <br /> 7.Transporter 2 Company Name <br /> '171j'!J' U.S.EPA I D Number <br /> 8.Designated Facility Name and Site Address s Z fq".Tr,!. <br /> U.S,EPA I D Number <br /> PIN P 101. <br /> 7 <br /> Facility's phone: <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Tow 12.Unit <br /> HM and Packing Group(if any)) Na. Type Quantity WuVol. 13.Waste Codes <br /> 'q r t;k i_ �" "fir: r - <br /> L <br /> 0 <br /> F- CA, <br /> 9 <br /> ru2 <br /> LU , <br /> ca <br /> A. <br /> 14.Special Handling imstructions and Additional I I <br /> n offnialion <br /> let' <br /> 15, GENEFLATOR'SIOFFERORIS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged, <br /> marked and labeledlpfacarded,and are In an respects in proper cond6an for transport acoordinq to applicable international and national govemmental regulations.If export shlpmeni and I am the Primary <br /> Exporter,I certify Ural the contents of this consignment conform 10 the terms of the attached EPA Acknowledgment of Consent <br /> I certify that the waste mInImzaliGn statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)w(b)(if I am a small quantity qwwcalor)isjw-f <br /> Generator roc Priqw'7� Signature —'-'- "? 'W' 'r. <br /> Month Day Year <br /> -J 16.frtftauonal Shipments <br /> r-- 0 Import to U.S. El Export from ASL Port of enWexit <br /> 'M Transporter sfgreture(for exports onty): Date leaving U.S.: <br /> L01' 17.Transporter AdveMedgment of Receipt of Materials <br /> Ll <br /> Transporter I PnnLDcUTyped Name <br /> Month Day Year <br /> Transpoft 2 PdnWffypod Na* <br /> Signature1. Month Day Year <br /> 13.Discrepancy <br /> 18a.Discrepancy Indication$pow 0 Quantity ID Type ❑R.,'d. ❑Partial Refection ❑Fu!I Reection <br /> I 8b,Alternate Facility(or Generator} Manifest Reference Number. U.S.EPA ID Number <br /> r+ Facility's Phone: <br /> ca <br /> Lu 18c.Signature of Ailernate Facility(or Generator) Month Day Year <br /> 19,Hazardous Waste Report Management Method Codes(i-e,,codes for hazardous waste Imatment,disposal,and reqding systems) <br /> LU <br /> ca 2. 3. <br /> I-) i Li i I I I 4. <br /> 20.Designated Facility 6m6r or Operator.Certification of receipt of hazardous mal0als covered by The manifest except as noted in Item 1 Be <br /> Pdnledffyped Name Signature <br /> Month Day Year <br /> EPA Form 8700-22 1Previous editioriq A <br /> DESIGNATED FACILITY 7'Q GENERATOR <br />