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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 for ID Number jp 2.Page 1 ofWcw&-,6V-?f <br /> y Response Phone{ 4.Manifest Tracking Number <br /> WASTE MANIFEST `3�LI 1 f 0 2 0 4 2 6�. JJ K <br /> 5.(enerator's Naame and Maili doss• ,/ �U C Generators S to Address(if d fFerent than mailing address) <br /> �evra�shone: 9 30^g�0v-q07 Q - ��J 7 <br /> 6. W�& 1Wr0gbtkA,Inc. �G IA 0 2 1 7 5 1 3 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8. 0WM� Name and Site Address U.S.EPA ID Number <br /> 0y,, <br /> UM I <br /> Kums CV AAO 641291 <br /> Facility's Phone: 816 924.54 M 0 D 9 8 1 1 2 3 3 91 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13 Waste Codes <br /> HM and Pacidng Group(6 any)) No. Type Quantity Wt.Nol. <br /> o ' L'i 31 � 1 <br /> 11.7 77Da2r <br /> 2.vol4 , AtAsrf Rtm m406t . 4 f DF g S!57X <br /> NO 3 a7clr�1. Gc. � 1 �- <br /> 3.G 2rfo`4 tVAS'r1-6A%4451,0f Llfry S <br /> I <br /> LU <br /> 1�U•41 C ��`1 C A105 <br /> C �uoCtf °A. <br /> 4. <br /> 1 LSpecial Handling Instructions and Additional Information 3• Ca tit.w �./� SLC"� S ���(�s <br /> F(* L l QV 1 43 4x.o L C/K ` . p-7(LOX/ <br /> 2 /� sLL-nt ClXiS� Wa <br /> 15. GENERATOR'SIOFFEROWS 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, <br /> marked and labeiedlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If exportshipment 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 262.27(a)(if i am a large quantity generator r(b)(if I am a small quantity generator)is true. _ <br /> Gener34oeslOfferor's Printed/Typed Name Signa 1pnth 0 Year <br /> 16.International Shipments <br /> H ❑Import to U.S. 0 Expo 10U.S. Port of a1exit <br /> M Transporter signature(for exports only): Date leavino U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> 1-2 Transporter Printed/Typed Na Signature Month Day Year <br /> tre-Lirl -i <br /> N Transoorter 2 PdntedlTvoed Name Signature Month Day Year <br /> J.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type 0 Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facil' s Phone: <br /> w 18c.Signature d Altemale Fadfily(or Generator) Month Day Year <br /> Q <br /> y19.Hazardous Waste Report Management Method Codes i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedrryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />