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Please print or type. Form Approved.OMB No.2050-0039 <br /> FIIA ' <br /> ARDOUS I.Generator ID Number 2.P 1 of 3.Emergency Response Phone 4.ManlfostTracking Number <br /> IFEST ��� lQ��-39elo 020426954 JJ K <br /> Eli A r Generalor's Site Address f different than mailin addressAGI�.v�►�jL � � � s ) <br /> a)e z 53 1.33® 7?A-A-- .m*yv s7- <br /> G4. 9234+ 4-. 9 Z S*V0 <br /> eneratos on, Roo, 8'60_Y073 Iv <br /> 6.TFa W WNfi1 aptg gMt1CSr Id.WU {A 2 1 7 5 1 <br /> 7.TranWorler 2 Company Name <br /> t1.5:EPA EDD <br /> Number <br /> 8,4VAth%dName and Site Address U.S.EPA ID Number <br /> 6(1 SbKWm Or <br /> Kama City MO 64129 <br /> Facility's Phone: 816 924.5M M 0 D 9 0 1 1 2 3 3 9 1 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10-Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 1, <br /> LLJ <br /> 2•('/114,-t; WASTi RA*kW,.*9Lj Lfk1>I.eS�MaS <br /> X A-LLD t-10 L f-S') <br /> X3.Ug2 i GO) IT.l.>> -rUe-,oDoL-"SIv1E L1.COJ 1pS Qy �bd'Z <br /> FMCKV�LA-,Jl OSI S( }� ��LCa L� � DIA/ 32— <br /> 14- <br /> U�1 Z 992 C1aA-5`rf wl�[-r�[ L14�s( ToK�[C{AIo <br /> ssi <br /> 1 . [71 <br /> Spe !HandNng lrtslnecGons and Additional Inform atlon r�, <br /> F-�oL Scr.JI OAS F-r��I V roTL) y0 rIT14A, oXIC- c. p r tcS-5 <br /> z> R/04, u cau v4% 61 V JT) Wo i4.moo e 023/tr <br /> 1) QA t 6mlowlas 0 ass) <br /> 15- GENERATOR'SIOFFEROWS CERTIFlCATiON: 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 certify <br /> that <br /> the rded,conte 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 <br /> Exporter,l certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment ofConsent. <br /> l certify that the waste minimization statement identified fn 40 CFR 262.27(a)(if I am a large quantity generator) (h}(ifl am a small quantity generator)is true. <br /> General fierors PrintedlTyped N Signalu Month DLa�y Year <br /> f <br /> 16.1nlemational5hipmenls <br /> F- ❑Import to U.S. ❑Evo t frc Port of ent xib <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> Wr 17.Transporter Acknowledgment of Receipt of Materials <br /> D Transporter 1 Prin a Signatu <br /> Month Day Year <br /> s <br /> Transporter 2 Arin yped Name I + 2-o <br /> a Sfgnalure Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 16b.Alternate Facility(or Generator) h lanifesl Reference Nornw. U.S.EPA ID Number <br /> U <br /> LL Facillty's Phone: <br /> W 18c.Signature of Allemate FaClllty(or Generator] Month Day Year <br /> B <br /> Z <br /> 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,dlsposal,and recycling systems) <br /> LLJ i 1 2. 3 <br /> 4- <br /> 20.Designaled Facilay Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Nmed/Typed Name Signature Monih Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />