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Form Approved. OMB No, 2050-0039 <br /> Please print or type. (Form designed for use on elite (12-pitch) typewriter.) '.. <br /> 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number g� <br /> UNIFORM HALARUOUS 008701284 J J K <br /> WASTE MANIFEST A 6 <br /> . Ge e¢mloqtsName Mailing Address <br /> �gGeier tots Site Address (it dwerent than mailing address) <br /> 5 <br /> V86 K ih\tt <br /> 0%71 Lxv <br /> gvW 6A agov <br /> Generator's Phone: ® �Q o U.S. EPAIDNumber <br /> 6, Transporter l GAAompany Name <br /> yy <br /> 6a' tly�K: it6dSEf8 a '��'� U.S. EPAID Number ', <br /> 7. Transport r2 Company <br /> area <br /> U.S. EPA ID Number <br /> 8. Designated Facility Name and SileAddress JA <br /> 0AJ <br /> cih s4hon - <br /> go. 9b. U.S. DOT Description (Includlng,Proper Shipping Name, Hazard Class, IDNumber, 10. Containers 11 . Total 1122: Unit 13. Waste Codes. . <br /> HM and Packing Group (if any)) <br /> No. Type Quantity wt./Vol. <br /> 41 <br /> WAWC 60"0 <br /> 4 <br /> 3. ._ .� <br /> fi <br /> g <br /> 4. <br /> 14. S ectal Handling.Igstmctions and Additional Information <br /> 15. GENERATOR'S)OFFEROR'S CERTIFICATION: hereby declarethalthe contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> 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 <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> 1 codifythat the waste minimization statement idenfified in 40 CFR 262,27(a) (If I am a large quantity generator) or (b) (ifi am a small quantity generator) Is We. Month Day Year <br /> Gen$emtotslofferdts PlintedfTyped Name UaGu Y� Signature <br /> C 62 <br /> J 16. International Shipments ❑ Import to U.S. ❑ Export from 0.5. Port of entrylexit <br /> Date leaving U.S:: <br /> Transporter signature (for exports only): <br /> CC 17. TranspoderAcknowledgment of Receipt of Materials Month Day Year <br /> w Trans oder 1 Pdn iufllyped Name Signature <br /> F <br /> g Month Day Year <br /> Transporter2VontemlypedGrName Sinature <br /> t- <br /> 18. Discrepancy <br /> 18a. Dlscrepancylndicallon Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> U.S. EPAID Number - <br /> 18b, Alternate Facility (or Generator) <br /> Zi <br /> U <br /> Facllitys Phone: Month Day Year <br /> w 180. Signaluro ofAkemale is F iI ly (orGenerator) <br /> 6 <br /> 19. Hazardous Waste Report Man4agement Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 3. <br /> 20. Designated FaciIlly Owner or Operator: Cermication of receipt of ha ous materials covered by the manifest except as noted in IteV8a <br /> Mo h D y Yea? <br /> Printedfiyped Name - Signature Il <br /> EPA Form 8700-22 (Rev. 3-05) Previo�t ns are ohsuRne, OFF GGvWN � bSTGNATION STA�E (IL= ����@��®D <br />