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Please"print or type. - Form Approved. 'OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number "' 2. Page 1 of 3. Emergency Response Phone 4. Manifest Track!n Number /� WASTE MANIFEST UF :£ t.l€Y11�r fi'7;'2 '? ;::0 - "2153 000 g 6 , DAT 5. Generator's Name and Mailing Address A1114: Arlt3,a71 i'7 )"'v`r}ye3u'd Generators Site Address (if different than mailing address) lo- atg, _ I & Fi V rr Generators Phone: 6. Transporter 1 Company Name U.S. EPA ID Number lit3a_ tElari's`o. y > _.3€ r fttet`s„ . "t�4`ltk f £t, 18 �s`_"=.t & SPtr :w7£i3 £t& :sem. - "> €."AROW179747 7. Transporter 2 Company Name U.S. EPA ID Number t.4 „<st � titlt+ f„ir€;:�, f <rrXhc�t ��sa -�+ l� E?uJ�"�u�r 8. Designated F cilily N me and S teAddress U.S. EPA ID Number ISLatf tr: c LL.G caq vE Facilitys Phone: go. 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 WINoI. 1.Frlr :4Y. 1fa , 2s� d�t'ra7€. . tsTy 6S=`1 t: c , vi ti.F, hyaya t.n:lYtau2e; rs.",ttl�, F% , i@ 792 `OX ,.WS Dir, 02 is (7 wrapte. t7'dkt, ti .ef. ,. (ORVV,-1 , <a eMyriO), UP , (1( a.Sx ocros xoAt F00 I 3. 4. y.. 14. Special Handling instructions and Additional Information r- 11 aflf ` J ' 2AQ P GflES' ya f k ( �dtP lliRf r { v. Com ..€sem st_ 1ta. rx ePpu . , , � _ t ter. , n s , rhe,.g r. #ts,. i#(ytu'a Ga-0 ..a aa.Y., .>e .v ' ea .4E'sk tie .. ra. _barns ztl(&PxOst e"&36f. ± UW5 15, GENERATOR'SIOFFEROR'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 labeled/placarded, 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, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization sta4,dent identified in 40 CFR 262.27(a) (if I am a large quantity generator) r fib) (if I am a small quantity generator) Is true. General Ys/Ofreror's FfIntedlTyped Nae �- Signature " Month Day Year y. . i.., I _ IF'str i 16. International Shipments I i- ❑ Impart to U.S. ❑ Export from U.S. Pod of entrylexit: ? Transporter signature (for exports only): Date leafing U.S.: W 17. TransporterAcknovAedgmentof Rowiptofgatenals Transporter i Pdnted/Typed Name e' %f Signature / f j ,,� Month Day Year a F`'<t'..�? �[ 'F P� 1 ✓' .;t. e ln.: t"` 1 . .�= .. 5 �,� r. G i +a' Z Transporter 2 Prinled[Typed Name Signature Month Day Year olr" 18. Discrepancy His. Discrepancy Indication Space ❑ quantity ❑ Type ❑ ResiduePartial Re ❑ jection ❑ Full Rejection Manifest Reference Number: F 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U ua- Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) - Month Day Year Q z N19. Hazardous Waste Report Management Method Codes (i.e., odes for hazardous waste Vestment, disposal, and recycling systems) 1. 2. 3. 4. 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted In Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GIaN BRAT®13'S INITIAL COPY