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it <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050 0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID --a pvgD I of 3,Emergency Response Phone 4.M If tTr Id Nulbor <br /> ull I <br /> WASTE MANIFEST <br /> 7 .5.Generator's Name a M-A-iringAddiess- 2 FLE- <br /> Generalor's 81(eAddr-ess(if different then malting address) <br /> b.I tanSPOrtOr I Company Name Vis;EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility NaWe and SiteAddressU.S,EPA 10 Number <br /> IF MY Ph <br /> L <br /> ga 9b,U.;DOT Description(including Proper Shl ping Name,Hazard Class,ID Number, 10,Contall of$ <br /> HMand Packing Group(if any)) 11.Total iZ Unit <br /> 13,Waste Codes <br /> No, Type Quantity Wt'JV0)' <br /> fit <br /> Z Ac") <br /> 2. <br /> LLJ <br /> 3. <br /> 4. <br /> 74.Special Handling Instructions and Additional InfoGOGpn <br /> r <br /> 4 <br /> "If�fit <br /> �J- <br /> y 16 <br /> I'S."dENEAT6W816FFERORIS tERTIFIGAVO ttil-Y a t 86&08�91J66'bl a-pfdpef ahtpping name;and are classified,packaged, <br /> marked and labeled/placarded,and aro in 61lx pec,s.in.ptopercondidorv.W.transpod.occording to applicable International and national governmental regulations:][export shipment and the Primary- <br /> Exporter,I cattily that(he contents of this cons[nmept conform to the forms of the attached EPAAcknowledgment of Consent, <br /> I Pe(Iilfy that the waste minimization statement I enVqed In 40 CFR 262,27(a)(if I am a large.quanlity generator)or(b)(if I am a small quantity generator)Is true. <br /> Generatoe Offeror's Printanped Name signature Month DAY Tear <br /> z4 16.Intem7bonal—ShIpmenis <br /> • <br /> f-1 Import to U.S. El Export from A/ Pod of entry/exit; <br /> Transporter signature for exports only): Onto leaving U.S.. <br /> LU 17.TransporlarAcknuMedgment of Receipt of Materia I-S-1— <br /> TranspoW>PrintecifTyped Name SignaturePonth Day Year <br /> Z — <br /> 0 <br /> hl�poer 2 PtinterFyped Name <br /> fldSignat'Ure <br /> Month Day ear <br /> L <br /> I&Discrepancy <br /> 18a.Discrepancy Indication Space <br /> El Q,a 0TYpe F-1 Residue <br /> FledwRejea, ❑Full Rejection <br /> Manifest Reference Number; <br /> 181b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> :3 <br /> L<1 <br /> Phon16c.Signature e: <br /> Facility(or Generator) <br /> Month Day ' Yearl <br /> Z <br /> v5 19.Hazardous We s[a Report Management Method Co as(1,0,,codes for hazardous wale treatment,disposal,and recycling systems) <br /> 1. 2 <br /> 20,Designated Facility Owner or Operator:Ce.flificalloi of ri celpt of hazardous materials coveted by the manifest except as noted In Item 18a <br /> Printedfryped Name <br /> Signature <br /> forth Day Year <br /> EPA Form 8700.22(Rev,3.05) Previous editions ari obsolete, <br /> GENERATOR'S INITIAL',COPY <br />