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iol so print or type.(Form designed for use an e lie(I' tch)typewriter.) <br /> 2-pi Form Approved.ON18 No.2050.0039 <br /> UNIFORM HAZARD01 IS. <br /> i.Generator ID Nimb 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST <br /> 7 ;!r 1 0, 16 4 E',)6 8 S S KS <br /> 5.Generator's Name and Mailing Address Genotatoes Si(eAddress(if different than mailing address) <br /> 6.Transporter I Company Nellie I U.S.EPA ID Number <br /> Vtl Aff <br /> 7.Transporter 2 CompanyName U.S.EPA 10 Number <br /> 3.Designa!ad Facility Name and Site Address <br /> U.S.EPA ID Number <br /> P <br /> j'.e <br /> Facilit I's Phone; <br /> 9a, 9b.U.S.DOT Description(including Proper Ship,ing Near%Hazard Class,ID Number, to,Confail ars 11.Total 12.Unit 13.Waste Codes <br /> HNI and Packing Group(it tiny)) i <br /> I No. Typo Quantity W1.1vo1. <br /> LU OA7 <br /> Z — 2 <br /> LU <br /> J, <br /> 3, <br /> 4. <br /> 14,Sp eclat Handling Instructions and Additional Informal!(n <br /> 7 G 1 1 7 <br /> AN <br /> Z. <br /> /0 <br /> Y tT 1 7E, <br /> ATION: I'lid?6by 6616ra <br /> t tt RtL#tR__$C_ �tFt at atbt tim h 'ingname,and are classified,packaged, <br /> marked and labeledlplacardod,and are In all respects in proper condition for transport according to applicable international and.rational governme all regulations.It export shipment and I am the Pilmaty, <br /> a <br /> Exporter,I certify that the contents of this const rim in to the terms of the attached EPAAcknowledgment of Conserif <br /> I certify that the waste mlairnization statement Ic ent=F11 262.27(a)(if lam a large quanlity,generplorytir(b)(it I am- small quanliry.g nerator)is true, <br /> .6066 Signalut%. Month Day year <br /> —j %lotafnalionalShipm is <br /> Elimport to L Elupwromu.s. 'rild.frontylat: <br /> :_ Transporter signature 2r,exports only): U.S,, <br /> 17.Transporter Acknovdedgment.of Receipt of Mateda s <br /> Transpo Pr1drlyped Name Signal re Month Day Year <br /> 0 <br /> a o24-1, <br /> Z Tranmr(Ur-2 Prifiteciff7ped Name <br /> Month Day Year <br /> I&Discrepancy <br /> 18a.Discrepancy indication Space FlOuantit, El Type EIResidue El Partial Rrile,litin E]Full Rejection <br /> Manifest Reference Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> LL Facililys Phone: <br /> w18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> ;,73 ig.Hazardous Wasip Re rt irrpaqen�ent Method Codes(I,e.,codas for hazardous waste treatment,disposal,and recycling systems) <br /> 2 4: <br /> 20,Designated FaciliYowner or Operator:Cerlificplloi of f <br /> ous materials covered by the manifest except as qded fit 11ijtm 18p- <br /> i ,celp�qf�azard <br /> Pfinted[Typed Name,. Signatures <br /> r ,f' <br /> Month Day. Year <br /> a <br /> EPA Form 8700-22(Rev.3.05) Previous editions at?rabsolele..", 1:!�810 1`1 ATE'D PACILITV TO a r—ti L.,n xr0R <br />