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-.i r{t i.J;}.•!f ..�1JF.�' ,�L-..� 'r V�t"'t Il" <br /> 1Cr <br /> Please print or type. Form Approved.ONIB No.20500039 <br /> •NIFORMHA7JaRDOus LGenernlorID umber 2. 1oi me t once one 4.hlanifastTrackinc�Number <br /> ',.f lt.t7i 1:1;7:':t511 '+f.,F'S / .t� t^,i r t"} FL E <br /> F1 <br /> WAST MANIFEST r 7 ' 4 8 <br /> a2 A-4- <br /> 5, <br /> .>5,Generators Name and Alailinq Addfess GePerator s Site Address(if different than mailing address) —' <br /> c;lt_ <br /> sJ Air- Gy}yf;,6:F3F, 1 ic' <br /> ;(of `'r7t h St r <br /> 9 ACRAi�i�E N11 ?. <br /> Generator's Phone 13 1;a"444—C:�5 31 <br /> 6.Transporter i Company Name 7 U.S.EPA ID Number�!i� y <br /> :i'!»C4{"iit_.» f`ii J^�•.ryJ le:. ' r .r I <br /> 7,Transporter 2 Company Name �U,S.EPA 10 Number <br /> 13VC !NCi <br /> 8.Designated Facility Name and Site Address r E N H 1y s0 n' SA ?'{�1 U.S.EPA ID Number <br /> �..� It �y [n'1 iT 1. 1 SAM ��71.". <br /> Facility's Phone: ;+ <br /> la, gb.U.S.DOT Description(including Props Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HManal Packing Group litany)) No; Type quantity WI.Nol. 13.Waste Codes <br /> 1' " P1!sP,( � #iAZ'ARI D 0 Ij 1131 WA13,V M (1-1;)!.,iriS lit+i <br /> i <br /> 1 14,Special Handling Instructions and Additional Info nation <br /> 24l( by gtnie-r,ator t'onfgr s s Bile. <br /> 15. <br /> FFEROR'S CERTIFICATION: I GENERATOR'SfOhereby declare[hat the contents of this consigtnmentara fully and accurately described above by the proper shipping name;and are classified,packaged <br /> marked and labeledlplacarded,and are in all re pact'I in proper condition dor 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 conslg tmar�tinnform to the terms of the attached EPAAcknowledgment of ConseppL �n <br /> i.V4fy'fh8t a waste minimization slateme kl inlifled in 40 CFR 262.27(a)(if i am a large quantity naratrfr} r(b)(1fl'h a small quanli y generator)tsi e'f <br /> eneratoi� rows riniediTyped Nam + r U <br /> Ll All, <br /> Day Year <br /> F t 9 <br /> F 16.international Shipments 1 import to U S. <br /> ❑Export from U.S. Pori of anhy/exit: <br /> Transporter signature(for exports only); ,..-Date leaving U.S,: <br /> W 17.TransporterAcknowledgment of Receipt of Materials <br /> t- <br /> Pri led/Typed <br /> Ctz/1 p <br /> h Sign ureTransO <br /> y Month Day Year <br /> CL <br /> llG-'7v, •-� JF''r�+'C.rf .tang ,.. <br /> TransporJter 2 Pnnted/Typed Name Signature Month Day !Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space quantity ❑7 e ❑Residue ! ❑Full Rejection <br /> YP ❑Pallial Ra'eclion <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> t7 T. <br /> W Facility's Phone: �. <br /> w 18c.Signature of Allerna(e Facility(or Generator) Monlh Day Year <br /> V) W.Hazardous Waste Report Management Method Gods(j.g„codes for hazardous waste treatment,disposal,and recycling systems) <br /> 3. <br /> 20.Designated Facility Owner or Op.rator.Certification f racelpt of hazardous materials covered by the manifest%xcels noted inIle iPrjnledlTypad meSf natuJ g atti + ' - Mp Da Y1,T Lr 1}, ( 7 <br /> GPA Form 8700.22(Rev.12-17) Previous editions ar obsolete, ( CJ fr NA7ED FACILITY't0 GENERATOR <br />