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M cA -13op <br /> v 2 1 0 <br /> N <br /> 7 -0CD <br /> v <br /> O <br /> O 4p, (D (D <br /> O <br /> IIIiI ae oCrI <br /> IIIIII�III —~V W <br /> M HazaRnous 1 re�ram,I„���;� � <br /> 1yA5iE MIWIFEST Pape I W a.Emergar y pespPn� 4.1111i t TrwIF <br /> � 5 ��"" 20558 FLE � CDGene,e Srte AdrlRss la dpremm Wnnudnq eodrmst O <br /> �: <br /> ET <br /> U 5 EP µmph (D <br /> a�sy�r!p c-erx3m Na^Y Z) <br /> U.5 Pq 10 Numex <br /> e.DeSprabE1 fr5ry Name avN$ile Adyjress D <br /> U.5 EPA ID Number <br /> Farpin'c m <br /> (n <br /> 9a. PL.u$,DOT nesoipaprr('rwudi P n <br /> ifkt sM Paaarg GrL-p li(anyll nxer$nppi�g Name,Ha<am Class.tU Number. 10.Container <br /> 11,7a1a1 tp Vnn <br /> O No Tvpe Deanlity Wr Va 13 was 'r4' <br /> Q <br /> rr <br /> w <br /> Z <br /> W - 7_-_ D <br /> I <br /> 1a.Speoal Har+deng InslruCtionS and Additional Inlormalion <br /> 15. GENERAiOR'SrOFFEROR'S CERTIFICATION:I hereby deGare'hal me contents of this consignment are fully and accurately described above by the proper shipping name,aid are GassifiC-0,I>ackagnd. <br /> marked aM labelediplacarded.amd are in all respects in proper condition for transport according to applicable intemadonaland national gouemmental regulations.II export shipment and I am the Pnmay <br /> Exporter I cemry That the contents of[his Consignment mnform lo'he terns of the attached EPA Acknowledgment of Consent. <br /> cedily Ina)tite waste minimi¢abon statement idenlfied in q0 CFft 262.27(al f81 am a large quantity generator or <br /> GeneratorsrOgeror's Pnnted�'fyped Name 1 @)lilt am a small quantity generator)is True. <br /> Signature Momtt Day Year <br /> � 1G Irlemational5nipment5 � <br /> 2 ❑Import to U.S. ❑Espoo from US. Port of entry(exiC <br /> Transporter signature(far exports only): <br /> Ir 17.Transporter AdeuMedgmenl of Receipt of Materials Dale leaving U.S.: <br /> w <br /> Transporter I Pdn'edrTyped Name <br /> aSignature Month Day Year <br /> Qorter Transp2 PdnfedRyped Name <br /> Signature Month Oa Year <br /> Y <br /> fa.Discrepancy <br /> 183.DiscrepancyIndioeban Space - <br /> ❑Quantity ❑Type Ll Residue <br /> Ll Partial Rejection Full Rerecbon <br /> 18hAlternate Facility(or Generator) Manifest Reference Number. <br /> U.S-EPA ID Number <br /> r <br /> Facility's Phone: <br /> H1Se.Signalura ofAltemale,Faci€ily)or Generator) <br /> Q <br /> hlornh Day Year <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment.disposal,and recycling systems) <br /> t7 LU 1. 2. 3. q. <br /> 111 Designated Facility Owner or Operator.O8r6ficatlon of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Prrnted/Typed Name <br /> Signature Month Day Year <br /> C) X <br /> C n <br /> EPA Form 8700-22(Rev.12.17)Prevrous editions ara obsolete. GENERATOR'S INITIAL COPY <br /> D ° <br /> I � <br /> CD •r _�,., Zl <br /> CD <br /> Y ` <br /> Cl) <br /> O C W <br /> 4�1 � <br /> (D W <br /> O <br /> M <br />