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Please,print or type,(Form designed for use on Ate(12-pitch)typewriter.) Form Approved.OMB No,2060.0039 <br /> UNIFORMHAZARDOUS 1:Generator Num lar 2t�.I of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST <br /> I n06495138 SKS - <br /> 6.Generator's Name and Meiling Address Generators Site Address(it different then mailing address) <br /> ' "-14 <br /> Gaderal6r's Phone I ;tK <br /> 6,Transporter I Compa;ii <br /> I <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facility Name and SileAddress U.S.EPA ID Number <br /> JZD�VN H1,r,J, <br /> W.) <br /> Facility's Phone: <br /> ga. go.U,S.DOT Description(including Propqr Shipping Name,Hazard Class,10 Number, 10.Cortall lots 11,Total 12,Unit <br /> No. Ys Quantity W111vol. <br /> Hhi and Packing Group(if any)) 13.Waste Codes <br /> 1, <br /> 0 <br /> L�-R ?Y Pi-! <br /> 2. <br /> 0 <br /> 3, <br /> 4, <br /> T—I.Spoclal Handling Instructions and Additional Inlorma ion <br /> rq, <br /> �111)5 13 J �%'11'l 711 <br /> P 0:1 Y #.1- ;ri, 7 e 0 SCI.! .1.5..1 <br /> er y de area are ctassi <br /> Ipac <br /> marked and labeledflilacarded,andla(e Irpil espets;In proper condition for transport according to applicable international and national governmental regulations,It export shipment and I am the PnAary" <br /> Exporter,I certify that the contents of this 6on,�ignrf ant conform to the terms of Ilia allachod EPAAcknowledgment of Consent_1cedily that the waste minimization statement�(den illed In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I amFg small quantity geneiratol)•fs true. <br /> 06nerator'slofforers Printed/Typed Na Month Day Year <br /> Z- <br /> -j 16.International Shipments <br /> El import I U.S EJ Eiiptirt from U.S. Pod of fintrylaxit: <br /> Transporter signature(for exports only): Date leaving U.S,: <br /> V,TransporterAcknowledgment of Receipt of Materials <br /> Transportla"I PA led. pad Name Signature Monih Day ear <br /> 0 <br /> 4`4 <br /> Tratifool'ter-2 Prfnt&drTyp6a Name Sign5lure modu.I Day Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Spaoefetity El <br /> Spam El Type ❑Residue ❑Partial Rejection hJ Full Rejection <br /> Manifest Reference Number, <br /> 18b,Alternate Facility(or Generator) U.S,EPA ID Number <br /> LL. Facility's Phone: <br /> Uj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> S2 19,Hazardous Waste Report Management Method Qodes(La.,codes for hazardous waste treatment;disposal,and recycling systems) <br /> 1. 2, <br /> 20,Designated Facility Owner of Operator:Certifies ion�qfwalptof li.zwdous.matorlals covered by the manifest except as noted In Item 18a <br /> Tmed(Typed Name signature Month Day Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions i re obsolete, GENERATOR'S INITIAL_COPY <br />