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Pleasepriv,1 or type.(�ortn des! ned for use on elite �-pitchForm Approved,OMB No.2050.0039 <br /> )typewriter) C,.' <br /> UNIFORM HAZARDOUS I.Genemtorll)NuMbei 2. y Response Phona 4,Manifest Tracking Number <br /> Emergency <br /> WASTE MANIFEST G"Al-k1k,(0 J.f"6 3i <br /> 0.-Gonemtoes N �100485�77159 SKS <br /> Nameand Melling Address nemorMOVA sl ss(,if different[ban allingaddreSS) i <br /> Generators Phone: 1, 2% <br /> 6.Transporter I Com any Namo <br /> U.S,EPA 11)Number <br /> 7,Transporter 2 Company Name <br /> U.S.EPA 10 Number <br /> B.Designated Facility Name and Silo Address Ca U.S.EPA ID Number <br /> I' CE I Bi"FRRY, fmqj) <br /> Facility's Phone: <br /> T'ga, 9b. DOTDosMpHon(including Proper Shipp ng Name;Hazard Class,ID Number, 10.containers ti. 12,unit <br /> IU U.S.'�IO 13.Waste Codes <br /> j'�� .,d Packing Group(if any)) <br /> Type <br /> No. Quantity widVol. <br /> WAfa'JJ' aw <br /> O ?;P <br /> le <br /> Z 4 <br /> Lu <br /> 3. <br /> 4, <br /> it <br /> 14.Special Handling Instructions and Additions)Inferno I <br /> i '313 03* 1 3 r)3 <br /> .-Llu <br /> 1H �Tjnll tMp,7 p Tr) 1Rr-.'rATW <br /> 16, GENERATOR'SIOFFEROR'S CERTIFICATIONjI I hereby declare that the contents of this consignment are fully and accurately described above by thoptoper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are In all res acts In proper condiffoh for transport according to applicable International and national.governmental regulations.If export shipment end I am the Primary <br /> Exporter.I certify that the contents of this consfij9man conform to the terms of the attached EPA Acknowledgment of Consent, <br /> -.1-cerilly that the waste Minimization statement Id filled 14 40 OFR202,27(a)(it I am a large quantity gonerolot)pr(W(III a for):Istruo, <br /> qn mall qu nlity, note <br /> me 2, <br /> ,MRS <br /> 'Genetators/Offoroft Printedfryped No <br /> Signature, Manch Day Year <br /> f <br /> t <br /> -j 16.International Shipments4, <br /> 0 Import to U 31 F]Export from U S iPod of enlrylexii: <br /> Transporter signature(for exports only): Date leaving U.S,: <br /> 17,Transporter Acknowledgment of Receipt of Materials <br /> tons o 6r PrInte yped Name <br /> 12 ' SIgnalurb <br /> 0 Month Day Year <br /> CL laW <br /> Transporter 2 Ponteallyped Name <br /> Signature Month Day Year.* <br /> 18.Discrepancy <br /> 18a.Discrepancy IndIcalton Space <br /> F1 Ounnilly, 0 Type F]Residue Partial Rejection ❑Full R.I.,11arl <br /> Manifest Reference Number; <br /> lab.Affamate Facility(of Generator) U.S.EPA ID Number <br /> Lj- Facility's Phone: <br /> u0i 18c.Signature ofAltemale Facility(or Generator) Month Day Year <br /> 19,Hazardous Waste Report Management Method Coosa(1,D..:codes forhazardous waste trealment,.disposal,and recyclingeystems) <br /> 1. 2,1 <br /> L20.Designated Facility Owner or Operator:Cerfi If Ifonj of to'olpt of hazardous materials coveted by the manifest except as noted In Item 18a <br /> PrinteMTyped Name Signature Month Day Year <br /> l <br /> EPA Form 8700-22(Rev,3-05) Previous editions are!obs late, <br /> GENERATORS INITIAL COPY <br />