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.:�"•ii;: si�; �:;i tlT�'li: 'f�w'^sv'�:`•K""';31;' <br /> Please print or type. ,f, _ �o ' Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS i.Generator iD umper 2 Pagl 1 of 31.E m rypoPy Re'p4>eP!:M,69344,03 <br /> stTraakin Number <br /> WASTE MANIFEST (.1:14)01463E,�1 1g ■��t ;��9,1 `�KS Generators Site Address plress) <br /> t.�l�sT:i1 f•1�Y' +;ir 4tdf'CCtf .f� t: �! � 's, r .. <br /> 231 4 �•th �2t � <br /> co 95aw-32m, <br /> Generat <br /> or <br /> 's Phone; pp fir` ji u+ C a <br /> o.T�79 i 6Jf1 or�t4i,.f�l�pRt�esys mmlr11N CU.S.EPA IDAumbar <br /> CXRv'��1i1Ji��1c�;J� <br /> 7,Transporter 2 CompanyName U.S.EPA ID Number <br /> i,LZ'PIN i!RKAOIREi ENV Y.RE 1<it��'1`1TAL SM 11MG. ( 1"Eti!(i✓'l.r�L,�.` 4? <br /> 8.Designated Facility Name and Site Address �' r•i U.S,EPA ID Number <br /> t.,pU�.l~rrlN 1�}I1,•11C1r11�13`,'xr3r1�S 1t5.311IN ,t313t: <br /> 1K11�A B r�R r�,C32A r�U7•�'iry {y <br /> _> Ivtlf)Irai;�s�l�f:;',14r <br /> Facility's Phone; <br /> 9a, 9b.U.S.DOT Description(including Prope Shipping Name,Hazard Class,ID Number, 10,Centel ors 11.Total V.Unit <br /> Hf,r and Packing Group(if any)) 13.Waste Codes <br /> No. Typo Quantity WI:Nol, <br /> ;( 1 <br /> M11993 <br /> P s'f <br /> o (1 t i f1p111fY1..3,`Yi wOE"'�1~fial..Q E 'ffiS }g <br /> I:°t:?trfkS(.1�S`f!BLw f.?'OUL i P@ Y 11 > .if � 0 <br /> z 2. <br /> w <br /> C7 <br /> I ' <br /> 4 <br /> 14.Special Handling.insirt ions-and Addiltonalintor nnU� r c, 7 <br /> 8A <br /> 7 <br /> 0 <br /> {, a Z ri <br /> 41.1 l�tsil=;sti,1'I�ltw`t#���, .r��t� 17Cf>�'��;1/w'fI't'I�T--Cn'�t"�t"t retained by rgerleratw' r„s�T1't�L1r'3 s <br /> initial <br /> Tl 9. 3 • I t?`(3 i i' t, a7 ti: •;t' �'Tt}rJI :1i1111( �y'rXrt=irlrs r <br /> .15. GENERA TOR'SIOFFEROR'S CERTIFICATION I hetebydeclare that the contents of this consignment are fully and accurately described above by the:propershipping name;and are classified,package, <br /> marked and labeled/placarded,and are in all ras ecisin proper condition for transport according to appiteable intemational and national governmental regulations.if exportshipment and I am the Pdmaly <br /> Exporter,I certify that the contents of this consig men conform to the terms of the attached EPA Acknowledgment of Consent, <br /> - --I certify-that the waste minimization stetemsnljtl ntified Im40 6fR2ti2-27(a}Qt f ama large quant _... <br /> - itygerserat )or(b)(dtamasmallquantiogenerator)19tnie-—✓- -- <br /> enera'ofs10 eror Ptioledtfyped Name Signe r r Month Day Yeah <br /> .j 10.Imemational Shipments <br /> F— ❑Import to U. . I ❑Export from U. Port of enirylexil: <br /> Transporter signature(for exports only); pale leaving U,S.: <br /> w 17.TransporterAcknavledgmentofReceiptorMaterial I <br /> Transpo rinled/Typed Name Signatuf� ,� Month Day Year <br /> CL <br /> O �y } <br /> z Transporter 2 rinl d/Typed Nam <br /> Srgnatute -+ <br /> Month Day Year <br /> .1, <br /> 18.Discrepancy I ' <br /> 188.Discrepancy Indication Space Quantity ❑T e El <br /> Full❑Residue ❑Partial Rejection I_1 Full Rejection . <br /> i <br /> 18b.Alternate facility(or Generator) Manifest Reference NumberU:S.EPA ID Number <br /> J <br /> V <br /> Facility's'Phone: <br /> 18c.Signature otAlternate Facility(or Generator) Month Day Year <br /> d -----� <br /> Z <br /> (n 19.Hazardous Waste Report Management Method Codes(f.ei,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1' 2• 3. 4. <br /> 20,Designated Facility Owner or Operator:Codification of lecelpt of hazardous maleriais Covered by the manifest except as nded in Item 18a <br /> Prin!edrTyped Name Signature <br /> Month Day Year <br /> EPA Form 8700-22(Rev.12-171 Previous editions are obs'tete. <br /> >:3��:;1'°�#t,. ', :;t'7 (h!��tF `GENERATOR'S.INITIAL COPY <br />