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Invoice: 472362 Receipt 29-00 42142 Manifest 019869074JJK <br /> Please print or type --------------- <br /> , ! �� <br /> UNIFORM HAZARDOUS I Generator lD Number Form Approved,CM0 No 2050.0039 <br /> Eme1117-n( <br /> hone 4.ManiFes[Tracking Numbtr <br /> WASTE MANIFEST <br /> CAR 0 l 27� rvu� 5 7 JJK <br /> RITI:AID#%49Ea Generatord ffer,t than mailing address)A) J'N,S WHI MAraAGERt`9 EAvTVALI rII f20Af,r 'iuyE �'I(a�7 i-2(IRi�TRA('Y.C:A 9537t.; T'�?-1 °Generalors Phone: 7'k : :•• '33:f7 <br /> 5 Transporter 1 Company Name <br /> u.S-EPA IO Number <br /> 7.Transporter 2 Company Name 4355 .'4 <br /> 1N�. 4.�t".A ^� l.y,.�ti,� 115_EPA ID Number <br /> 8.Designated Facility Name a d Site Address M00 Oq:'030.!3',f�#, <br /> Ii.'.-i .,, <br /> - i t� >`.%)�.,�,c�i (i.fl_Eil l U5 EPAiDNumber <br /> Facility's Plane .y t'312- <br /> 9a <br /> '9a 9b.U.5-OCT Dasaiption including Proper5hipping Name,Hazard Class,ID Number, <br /> HM and Packing Group(ifanyJ) I0.Containers 11.Total 12.Unit <br /> No. Type Quant 111 13.Waste Codes <br /> k d:s#it, ,._; si,1 ^� ,,s tE�r 7 F-r�dUii 'Oc7a Jf 0©�#�5 P <br /> W <br /> W 2. <br /> ('J <br /> 3. <br /> 4. <br /> 14,Speaal Handling Instrudens and Addi-m—a Inionnaticn <br /> 15. GENERA TOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are Putty and accurately described above by the proper shipping name,aid are dessified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.ff export shipment and I am the Nmary <br /> Exposer•I certify that the Contents of this consignment contemn to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimizadon stall identified in 40 CFR 262 27(a)(if I am a large quantity gerreraror}or(b)(ill am a small quantity generator)is true. <br /> aror's101ferors PHntetllTy�predUName �15 <br /> ; <br /> Ail. j 1 a 1 ri i�`�yy�.�, 'i Month Day Year <br /> 16.International Shipments l L ''` + ` `' <br /> i ❑Impart to U-S. ❑ Port of !exit <br /> Transporter signature(for exports onift <br /> Date leaving it-5.: <br /> 17.TransporterAcNnowledLu greed of Receipt of Materials <br /> a Transporter I Prirdedlfyped Name <br /> Monh Day Year <br /> wa b1i11� r <br /> i Transpa ter2I'redRyped Namefn 0 h 1 118 <br /> M��-g <br /> *,A /1 1.r4 Month Day <br /> Year <br /> 18.Discrepancy (/ <br /> laa_Discrepancy Indication Space <br /> ❑fluantlty ❑Type ❑Residue ❑Partial Rejection ❑Ful!Rejec6an <br /> i~ 18b,Akernale Facit Manifest Reference Number: <br /> dy{or Generator} <br /> U.S.EPA ID Number <br /> U <br /> w Facilllys Phone: <br /> LU 18c SignaWre dAllemate Facility,(or Generator) <br /> Q Morrill Day Year <br /> Z <br /> y19.Hazardous Waste Repos Management Method Codes(ie..codes for hazardous waste treatment•disposal,and recycling systems) <br /> 3 <br /> ti144 4. <br /> 20.Designated Fatillty Differ Of Cl CemSCation of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdrdedlfyped Nam SignaWre <br /> Month Day Year <br /> EPA Form 8700.22(Rev.12-17)Previous eti are obsolete. DE5IGNATED FACILITY TO EPA's e•MANIFESTT SYSTEM <br /> Page 2 of 14 11517686 <br />