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M cn — cn <br /> CD = o <br /> � <br /> CD W O m <br /> v < Oos?D <br /> -n0 <br /> 0 <br /> o CL (n 0 w <br /> o it <br /> 3 o <br /> cn <br /> NIFEST ned for use CD <br /> onNuman„I,.1+li hi�Ylew„I,.,i _ <br /> RDODS t.cartaralw lU <br /> nie ehp M1fa Irng Artprass __�- �I� <br /> 1 <br /> ene <br /> onlPdnY <br /> O <br /> r2Cu-navy Narhe <br /> FacelN Name and Site Adpresn <br /> sn on 1, U) <br /> ya, u_5,D07Descnption O <br /> Packing an GrouP yd'nUuding Proper Shipping Name n <br /> lif , <br /> O <br /> n <br /> D <br /> 14.Spee7ai Handling Instructions andAdditlonal Information <br /> t5. GENERATOR'5lOFFEROR'S CERTIFICA710N:I hereby declare that the contents of Ihis consignment are full <br /> v-de.I densefed/placarded,and are in all respecfs rn proper rond,t.for hanspon according to applirabfe international and national avemmenl- Mations if e <br /> Exporter.f ceNty that the contents of this consignmem ,form to the terms of the attached EPA gcknowledgmeet M Cans mell- y descnbed shove ay the Om7ar shipprtg name,n a a c I a,,p P; ,., <br /> i cer[ly that the waste minimization statement idenlienf in fo CFR P6 f el7ms]of f e a a la g "pod�” "f enc ar.,ae Qrraarr <br /> Generators! eror's Prinled/ryped Name 9e quantity generator or til l am a small quantity I I q ty generator',is true <br /> gna ure <br /> 16.Ofemattonal Shipments <br /> ~ ❑Import to U.S. <br /> Trans m,,Sr nature Lorex ons ortl ❑Enpon from U.S. Fonofentrylesit <br /> C 17 Transp4def Acknowledgment o(Receipl olMaferials Date leaving U.S.. <br /> w <br /> Transporter 1 Prir, d/ryped Name <br /> O gnafine <br /> IL <br /> CTransporter 2 Prinled/Typed Name <br /> I r Signature <br /> NDaygar <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space <br /> ❑Quantity Type Residue ❑Partial Rejecton FUR <br /> Rap000 <br /> f8p Alfernale Fatality(or Generator} Manifest Reference Number. <br /> � LL5.EPA ID Nurtlber <br /> U <br /> a <br /> Fapli 's Phone: <br /> Ff8c.Signature ol'Allemale Facility lar Generator} <br /> 2 Nlplpt Pur <br /> m19.Hazardous Waste Report Management Method Codes li.e.,codes for hazardous waste treatment,disposal.and recycling systems) <br /> 2. 3 <br /> 26.Designated Faaflty(honer or Operator:Certification 4f receipt of hazardous malenals covered by the manifest eycepl as opted in Item 18a <br /> Prmted?yped rJame Signature <br /> A'mnlll Day Ytlar n <br /> C CD <br /> Form 8700-22(Rev.M5) Previous eddons are obsolete. n <br /> O <br /> GENERATOR'S INITIAL COPY D a <br /> � = O <br /> CD <br /> w <br /> N � <br /> W ;y < O <br /> rs < Cr <br /> v W <br /> O 1n <br /> W (D W <br /> 00 <br /> v 00 <br />