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<br /> Please print or type,(Form designed for use oll�olits(12 pildh)typewriter) Form Approved.O)v18 No 2050.0038
<br /> UNIFbRM HAZAAE) US ber 2.Page 1 of 3.Emergancykespcnse Phone 4,Manifost Tracking Number
<br /> WASTE MANIFEST 1,Generator ID'Numl �,w ;U � '1tCio 1 s; t
<br /> 5.Generators Name and MaikngAddress Generators SfilAddross( diffemrit than maifingaddress)
<br /> I0,9 SKS
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<br /> Can ralors A'onte", �x I f 1,1 1,
<br /> 8 Transporter 1 Company ameU.S,EPA ID Number
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<br /> :;`i';a(C:4ri" _ I IXF�!I tttlVtci'!-:' i
<br /> 7.Transporter 2 Company Name U.S.EPA ID Number
<br /> " ( f•) l �Ia; (tri) ) tf.r r.toi ml 3Intiire_8 INC
<br /> 8.Designated Facility Name and Site Address U.S.EPA ID'Number
<br /> J Ws:1 )�C:}t�+Yf �F3la i��3(�
<br /> Facility's Phone; ri•>y..fit ri .... r)s r ,
<br /> V",M)C11 1. 49314i�.q1
<br /> ga, 9b.U.S,DOT Description(including PropirShipping Name,Hazard Class, nit U
<br /> 1
<br /> Total 2.
<br /> ID Number, 10,Containers
<br /> HM and Packing Group(if any)) No, Typa Quantityti.TTootal 2,Unit 13,Waste Codes
<br /> 1.
<br /> W3 dj ti NON RC RA ��iA�.F��MILJt,; �i���3I 51-Ir�f35 �f+� P
<br /> (j,,r M1v7i, I #,.I RI.)(RIJA "IY).5)��iZ.AR-5f,IM)
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<br /> 3.
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<br /> 4.
<br /> 14.Special Handling instructions and Additiona In rmailon S1)1
<br /> )"a Sy �. 4y 337Ju
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<br /> zlri8-'-1.760 (MSI{ t TED
<br /> i . G E 'TbR'5/OF}rEF1 'S W r FICA FlibrhbydWiAreFifil,th4'U6iNnlnl-ot is' ==MM name,.ardare classified,packaged,
<br /> marked andiabeled/placerded,and are in all rspec s In proper condition for transport according to applicable intemagonaland national governmental regulations.if export shipment and I am the Primary
<br /> Exporter,I certify that Die contents or this consignmE nt conform to the terms of the allached.EPAAcknowledgment of Consent
<br /> 1,genify that the waste minimization statement i enlilled in 40 OFR262.27(a)(if I am a large quantity generator)or(b)(ill am a small quantitygdneralor)is true.
<br /> Generatoes(Offeroes Pdntedryped Namel, Signature
<br /> U. i Month Da Year
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<br /> —r 16.InlernationatShipments " •
<br /> ❑Import to ,S, 0 Export from U.S. Port of entrylexit•
<br /> Transporter signature(for exports only): Date leaving U.S.:
<br /> 17,TransporterAcknowledgment of Receiptof Matadi Is
<br /> Transpo.of,f nntetl/Typed Name Signature
<br /> p t Morifh Day Year
<br /> a
<br /> 4 Transport r Prl edff ped NamV Signature Month Day Year
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<br />` 18.Discrepancy
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<br /> 18a.Discrepancy Indication SpaceEl Quanli ❑T pe
<br /> Y ❑Residue ❑Partial Rejection ❑Full Rejection
<br /> Manifest Reference Number.
<br /> 18b.Alternate Facility(or Generator) IU.S,EPA 1DNumber
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<br /> u Facility's Phone: I
<br /> w i8a8igna(ureofNlernaleFacility(or Generator) Month pay Year
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<br /> i9:Hazardous Waste Report Management Method Codes{,e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> LU i. 2
<br /> Ll20,Designated Facility Owner or Operator;Certificatio of r ceiptof hazardous materials covered by the manifest except as noted In item 188
<br /> Pdnledrryped Name Signature. NonUr Day 'Year
<br /> EPA Form 8700.22(Rev,3.05) Previous editions are obs fete, GENERATOR'S INITIAL DOPY
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