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Plea,.so pri, )r type.(Form designed for use on ejile( 2 pitch)typewriter.) Form Approved.OMB No.20500039 <br /> UNIFORM HAZA"OuS 1 1.Generator ID Num4r 2.Pago I of 3,Emergency Response Phone Manifest Tracking Number <br /> WP*C4 MANIFEST ! *;1" —.; 111 �1, <br /> . � .1���N 1' 006466340 SKS <br /> 5.Goneralor's Name and MallingAddress Generator's SHoAddress(it different than mailing address) <br /> Generator's Phone yr '"' <br /> "4 <br /> 6.Transporter 1 Company NameU.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA 11)Number <br /> 8,Designated Facility Name and Site Address U,S,EPA ID Number <br /> Facility's Phone; <br /> W <br /> 98, 9b,U.S,DOT Descriplion(including Pfope Shl+ng Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 41.Total 12.Unit 13,Waste Codes <br /> No. Type Quantity W(1fV011 <br /> 1, <br /> 0 <br /> Z 2. <br /> W <br /> 3. <br /> 4, <br /> td.Special Handling Instructions and Additional Ink rmalion <br /> Nr boFV 61Wng name,and are classified,padaged, <br /> lV-;MEMT RM�4�Z 191'K�MiCA. 4: ilethby db'd'Ilro r�6�t!g rf,j—,�j I X 'N <br /> 'f�tj rj;Ln6; <br /> ,ij; nt'd-&9kya['4R role Mrlb; IK��M�' <br /> marked and labeled/placarded,and are lriall reispeds in proper conditlon for transport according to applicable International and national governmental regulations.lfoxpott shipment and I am the Primary <br /> Exporter,I certify that the contents of this corelpriminteonfonn to the terms ofthe attached EPAAcknowledgment of Consent, <br /> I certify that the waste minimization statement) entified In 40 CPR 262,27(a)(if I am flarge quantity generator)or(b)(10 am a small quantity gapefelor)1s468. <br /> Gene rator'siOfferor's Pdntedrryppd Nam Signature Month Day Year <br /> —16,international Shipman import to J.S. El Export from U.S. ✓ jkrt Of entry/sxff: <br /> Z Transporter signature(for exports only): Dole leaving U.S.: <br /> UW 17,rronsporter Acknowledgment of Receipt of Mated Is <br /> Transpqj1qp4 PrintecifTyped Name Signature Month Day Year <br /> a. <br /> z Trad§poftal"2 Plinft/Typed Name Signature "Monin Day Year <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space Ouan(ly R Type FIResidue ❑Partial Rejection EI Full Rejactlori <br /> ManifestRaference,Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U. Facility's Phone; <br /> 0 Signature ofAllarnato Facility(or Generator Month Day Year <br /> A 19,Hazardous Waste Report Management Method Codes codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4 <br /> T � <br /> Ll20.Designated Facility Owner or Operator:Cerifficalloo of ocept of hazardous materials covered by the manifest except as noted In Item 180 <br /> Ptinled/Typed Name Signature Month Day Year <br /> EPA Form 8700.22(Rev.3-06) Previous editions a e obsolete. GENERATOR'S INITIAL COPY <br />