Laserfiche WebLink
Please print or type.(Form designed for use on elle(11�.pltch)typewriter.) Form Approved,OMB No,2060.0039 <br /> 1,Generator ID Nui ale of 8 <br /> UNIFORM HAZARDOUS 3.,Emergency Response Phone 4.Manifest Tracking Nurn at <br /> WASTE MANIFEST SKS <br /> 0 0 6`3 14 1. <br /> F� <br /> 5.Generator's Name and Mailing Address Generators Site Address(f(differant than mailingaddress) <br /> U,Transporter I Company Name U.S.EPA ID Number <br /> T <br /> 7—.Transpoder2 Company Name U.EPA ID Number <br /> 8.Designated Facility Name and SlieAftess VS.EPA ID Number <br /> L Ui <br /> LCM <br /> rY <br /> Facility's Phone; <br /> ga, 9b.U.S,DOT Description(including Proper hipping Name,Hazard Class,ID Number, io.containers, 11.Total 12.Unit 13,Waste Codes <br /> IM and Packing Group(if any)) No, Type Quantity WtVol. <br /> W"',R <br /> T <br /> F- <br /> 2, <br /> LU <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Irdomatil n <br /> 8;7jo(I Mdv`dS7(�j classified,packaged, <br /> 1.)euy declare Met th4lAtentiof-Wis MA 0i6000110pin.9 name;and are <br /> 157%arn =rlaiav- <br /> spec a In propercondillon for transport According to applicable international and national governmental reguleflons,if export shipment find I am the Primary <br /> marked and labeled/placcarded,and are in all r <br /> Exporter,I cadi(y that the contents of this tons arm at conform to the terms of the attached EPA Acknoviladgnient of Consent <br /> sail led in 262,27(a)(if am a large quantity genarat6jr),9(0)(if 0 smallquantii aneratot)is tru.a/ <br /> 10flily that the waste minimization statement month Day y <br /> J, <br /> s Pfintedrryped Name f "llpl` <br /> Yeneratot's/Offem.e <br /> vvp <br /> -j 16.International Shipments Import to'U'S. El Export from U.S. Pod of en4lexit! <br /> Transporter signature(for exports only): I 1 Date leaving V.S,: <br /> C4 17.TransporterAcknoWedgment of Receipt of Materi 318 <br /> ul - Month Day Year <br /> Name Signature ,Transp 9 1 P n a ype <br /> I I , /. -?'1/ 7 <br /> CL '/ �v -0 -7 ' -� <br /> X//i Month ay ! Year <br /> 'i—ranspoder 2 Printedfryped Name <br /> 18,Discrepancy, <br /> 18a,Discrepancy Indication Space ,quantity Ehype ❑Residue Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> ........... <br /> 18b.Alternate Facility(or Generator) U.S,EPA ID Number <br /> Facility's Phone: <br /> Month Day Year <br /> LLJ 18o,Signature ofAllemato Facility(or Generator) <br /> Z <br /> 01g,Hazardous Wasle'Repbrl Management Method Code, fl codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ 2. 4. <br /> 20—Dsslgn.led Facility Owner or Operator:Cortin Zion 4f receipt of hazardous materials covered by the manifest except as noted In liern 18a <br /> PrintedfTyped Name Signature Month Day Year <br /> GENERATOWS INITIAL:COPY <br /> EPA Form 8700.22(Rev,3-05) Previous e illons ie bsoleta: <br />