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Please print o.,type. Form Approved.OMB No.2050.0039
<br /> ous 1.Generator ID Unit or 2AP a I of 3.Emi'noy Response Phone 4.Manifest Tracking Number
<br /> UNIFORM HAZARD 11, 1
<br /> 13'0--
<br /> WASTE MANIFESTCOU 0 1006762312 SKS
<br /> 5.Generators N6mearid Mailing Address
<br /> —Generator's Site Address(1fd1flarent than mailing address)
<br /> �Ai r �1,,S t
<br /> t t 1;
<br /> Generators Phone: 9 t 6-6t A,-Friq!5,
<br /> 6.Transporter 1 Comrap U.S.EPA ID Number
<br /> r.
<br /> 133 r,I E,I N y S
<br /> 7.Transporter 2 Company Name U.S,EPA ID Number
<br /> sn INC.
<br /> 8.Designated Facility Name and Site Address C i,.'()N H;1flJWJR9 SnIq 105t� U.S:EPA ID Number
<br /> J.1 21 ROM CAD059 -,
<br /> 21 '494,-
<br /> Facilit Phone: 10
<br /> 9, Ob.U.S.DOT Description(including Propf shipping Name,Hazard Class,10 Number, 10,Containers 11.Total 12.Unit 13.Waste Codes
<br /> HM and Parking Group(if any)) No. Type Quantity WIJVol.
<br /> N-0,N RtNA RAZ(Akoous (AA5TrE..,B0I'J1)3, tJ P
<br /> 0 t 1 IPS I P,0 L E 1-14-01 �-i IM F!0 C A FIB Cil�,s N A
<br /> W
<br /> 0
<br /> 3.
<br /> 4.
<br /> 14.Special Handling In7tr7lions and Additional.4 form Won
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<br /> 24H rltract retain.ed by generator COTIfWfIS Oqillli;�y aUth(ilrit ,
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<br /> 15, GENERATORISInFFFROR'$CtRTIFICATION: I hereby declare that the contents of this consignment are fuilyand accurately described above by thepropershippmg am aid are classified,pack4ed,
<br /> marked and labelediplacarded,and are 11,all resp j n proper condition for transport according to applicable International and national governmental regulations,It export shipment and I am the Primary
<br /> Exporter,I cattily that the contents of thiel co sign conformi to the terms of the attached EPAAcknowledgment of Consent.
<br /> I certify that the was' minimization statemac tide.tried In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(imam a small quantity gen tor)lsfruol
<br /> nera-(s/Offeror!s Prl ed/Typed Name5rgnelure Monti Day
<br /> Year
<br /> iA
<br /> Intermadon9l'Shipmelts
<br /> El Import o Export from U:S, rt of entry/exit:
<br /> Z Transporter signature(for exports only): alaleavieg U.S.:
<br /> 17,Tra nspofterkknowledgment of Receipt of Matrials'
<br /> Nf I Printed TranP
<br /> ? y Name Signature Month Day Year
<br /> 1p
<br /> 0
<br /> 4-4 4
<br /> re (ffoat fi f Dal, fYoW
<br /> Z TraIrspoP 1.44rterZ yoodNaW
<br /> 18.Discrepancy
<br /> 18a.Discrepancy Indication Space F1 Qu nifty RType El Residue ❑Partial Rejection ❑Full Rejection
<br /> Manifest Reftrance Number:
<br /> 18b,Alternate Facility(or Generator) U.S,EPA ID Number
<br /> Facility's Phone:
<br /> PU 18c.Signature ofAllernalrFadfity(or_Geno(ator) Month Day YPar.
<br /> q
<br /> Z
<br /> Hazardous Waste Report Management Who Co as(i.e.,codes for hazardous waste treatment,disposal,and recycling,systems)
<br /> 2.
<br /> 20,Designated F cliily Owner or Operator:Cerlific ollon of receipt of hazardous fnaterials covered by the manifest except as noted In Item 188
<br /> —
<br /> fear
<br /> PrIntocirryped Name Signature Month Day'
<br /> EPA Form 8700.22(Rev,12.'.17�Prevlouseditio6s ate-obsolete, GENERATOR'S INITIAL COPY
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