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S'i <br /> Please print or type, 'Form Apptoved.OMB No,2060-0039 <br /> UNIFORM 1,Generator ID umber Pa I of <br /> I one,Ras Phone <br /> WASTE MANIFEST 760 <br /> S.General SKS <br /> or'sNameand Mailing Generators iteAddross areas) <br /> '1�i V, 16'Y'%J;e 11,D I� <br /> '7 113 <br /> U <br /> N <br /> G <br /> W <br /> t_I <br /> a <br /> F <br /> WASTE R <br /> TM <br /> E <br /> 0 <br /> M <br /> r <br /> H <br /> A <br /> N <br /> I <br /> Name <br /> A7 <br /> s m <br /> A <br /> IF <br /> a <br /> R <br /> E <br /> MHA=7ARDOUS 1,GmrorAloID 4 <br /> DOU' .0 <br /> 0 <br /> �E IN I F ES'�= .1,evil I+( Ph-n= <br /> f-)=Ls E,- <br /> M <br /> as V d1fralont than <br /> Generator's Phone: <br /> I T C <br /> -T"s _I V 1 V 0 any, <br /> IoT a] <br /> us,E TD Number <br /> 7,Transporter 2 Compan <br /> y Name <br /> f S.—EPA TD Number— <br /> "'LEXIN HPIRBU'RE <br /> 8,Designated Facility Name and Site Address <br /> &EAN HMM801183 8;4j U.S.EPA IDNumber <br /> 1021 ;IURRYEGISM KIM <br /> Facility's Phone: <br /> 9a, 9b.U:S.DOT Description(including Propoi Shipping Name,Hazard Class,ID Number, 10,Containers <br /> HM and Packing Group(if any)) 11.Total 1Z Unit 13,Waste Codes <br /> No. type Quantity wl.rva <br /> lumber F1O Containers <br /> F12) <br /> No,C W <br /> I-1VQI <br /> w P7, -.TIT <br /> 0 MEB PETROL.R. I VD' <br /> Z 2. 70 <br /> LU i <br /> 4, <br /> 1-4 S-p671 Handling—1njuotions and Addl Fion—al atian <br /> T.9 1) 13 ,1 <br /> i. �VTIVY al.kt 10011, <br /> 15, NERATORIS/OFFER6 <br /> GE' �11'8 6ER'FINI-CAI-R& I he�' <br /> etrycleclarethat[fie contents of this consipmentere fully and accutajelydescribed`aboya�by <br /> marked and labeled placarded,and are in all res ��Iho proper shipping name,�rd are classified,packaged, <br /> acts in proper condition for transport according to OPPIICB610 international and national govemmahlal regulations.If export shipment and Ilan)the Primary <br /> Exporter,I certify that the contents of this consig, to the termsof the a8ached mowledgrqenj of Consebt, <br /> certify that the w3slO.MirimizAtion statement Ich nli8edin 40 CFR 282:27(a)(ittam a large <br /> generator)o (b)('I*l a small quantity generator)Is true. <br /> I am <br /> Signature, <br /> Month Day Your <br /> Generatoris/offatoris PrintecIffirped Name <br /> 3. El Export U.S. P�Pertof entrytoxil: <br /> -1 16,International Shipments ❑ <br /> Impod.t.U. <br /> Transporter signature(for exports only): <br /> _,-Delo leaving U.S,: <br /> 17.TionsprorierAftoWedgment,of RooelptofMaledols <br /> LU <br /> Trans .1 PrInted[Typed Name <br /> Signa(Ore <br /> 0 >e Month Day Year <br /> Transport 15 <br /> 2 Printed me <br /> Signature <br /> Month bay- Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space <br /> QuanType ❑ <br /> f 71 tity i <br /> Residue ElPartial Rejection Full Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Referem&.Number: <br /> U.S,EPA ID Number <br /> L-C Facility's Phone; <br /> Uri180.Signaluro of Alternate Facility(or Generator) <br /> Month Day Year <br /> ig.Hazardous Waste Report Management Mel <br /> hod Code (Ie),codes(Or hazardous waste llealmonl;disposal,and recycling systems) <br /> IIJ j. 2 3 <br /> 4. <br /> 20.DesignatedFacility Ovineror Operator:Cort ficallon o recaipfof hazardous materials <br /> covered by the menlreSt"CePI as ACtedLin Item 18a <br /> Printed/Typed Name Signature <br /> Manlh Day Year <br /> Ll <br /> EPA Form 8700-22(Rev.12-17) Previous editions are bs6late, <br /> 7 6"5"12,/7 J4 -j 16`8 1E GENERATOR'S INITIAL COPY <br />