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Please print r type. ForrnApptoved OMB No.2050-0039 <br /> TUNIFORM HAZARDOUS 2 Page 1 of 4.Mnifggt c n utpp-8 <br /> WASTE MANIFEST D 0 0 9 ' 4 $ V ,2 H Z 1 u 1 r75 F L E <br /> ;enaralnr'i;Narrw and Mtmhnq,rvldress Generalc's SiMAddress A wftrenr than-raalirg address) <br /> -ASS C ONO TA0,1EF <br /> FiEr>s2.'ala�3 Pi•lorle_ `' ii Lb h 3 <br /> 5 TmnS¢D w 1.Comm Name US EFA ID Number <br /> FNVIR()WAFNIAL & GHE M ICAL CONSU!_f'ING W -4 R 0 0 Q 2 't 1 4 4 <br /> 7 Transm4ar:Company Namek _�L '� • L tr 5 EPA ID Humber Jy� - Y- << <br /> L-14 V- * C� b*x Ct)MSOL7I - NC ' A -A-R--0--0-0 <br /> 8v Dees"' d Facility Name and Site Address U.S.EPA ID Number <br /> ;a rr Cr t JS',.;e.G A <br /> HIGHVAY 9y''5 ••f, 11 MILES SOLCI- OF BEA77' <br /> BE.A'-f'-, NY 83Ot I <br /> 239-3943 V T 3 3 0 0 1 0 a 0 0 <br /> ga. 9b U S DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10 Containers 11 Total 12.Unit <br /> HM and Packing Group('d any)) No Type Quantity W!Noi 13 Waste Codes <br /> Hazardous wast+i..SrAld,n,o s tClworl'yt.m),9,PGoi OP 008 189 <br /> 75- r 014 <br /> ly <br /> 4_A8077 Hazarduals waste,so)9d.n.,, s-(CMchfrdtn ,) ;.POW M E 1007 !008 18 <br /> lo,-f;CRA KarerdouS'11,.6sts St*d(O*e C�ebr�s; <br /> f7 DM 26ar P, ss� <br /> 14 Spemg Kweing Instructions and Addwnal InformaWn t if<i&A F RZ7W,j If t_7 E}2) <br /> ;y,L,`SI CHROMiIJM PR#x370128303-1270 3)9bi 0L Oew:S PRO 1"42",7R--27!�SSD 4)98)(3I42� 1ATER 9'C, <br /> �7>'��;s•-7P-'�?'9 Bf:1_ECL tN,.it�#----AL1--"'�- <br /> I r7JCr AZ <br /> 15 GENERATOR'SIOFFOMS CERTfFICATKA:I hereby declare that Me contents-of this oorhsignment are fully and amMely,•deswlbed above by the proper shipping name,art are classified,packaged, <br /> marked and labeled/pfacarded,and are in all respects in proper condition for transport acom ing to applicableinlertraWruvand nMioro goverrarren49 regsdaWru If export shipment and i am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> i certify that the waste minimization statement identified in 40 CFR 262.27(a)(f I am a large Queasily generetor)or{b}jdl am a srm#guentity genelor)is true. <br /> GeneraweVO mics PnntsdJyped W" h Signalare Mrrnth Day year <br /> J 16 Intemiathnai S*men <br /> Irnpo u S ❑Expolt from Us Port of entry/exit <br /> ? Transporter signature(for exports only): Date leaving U.S. <br /> W 17 Transportidr-Aidt"edgrnenl of Receipt of Materials <br /> If- Transporter 1 Printed/Typed Name Signature Month Day Year <br /> � K <br /> Z i Transporter 2 PrintedlTyped Name Signature — - -- Month Day Year <br /> ., 1 }} <br /> 18 Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type El Residue ❑Partial Rejection El Full Rejecfidn <br /> Manifest Reference Number <br /> 1 Bb,Attemeta Facility(or Gerw. MI US EPA ID Number <br /> J <br /> U <br /> g Facilitys Phone: <br /> W 18c.Signature of Alternate FadTdy(or Gereratar) Month Day Year <br /> 4 � <br /> Z <br /> [y 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2 3 4 <br /> r I <br /> 20.DeshgrsF�m Faaalrg Owner or Opwvbr.Certification of rempt of hazardous materials covered by the manifest except as no d.in Item 18a <br /> Prince yped Narne. Signature __ Mtsnlh Day rear <br /> Lq <br /> EPA Form 8700-22(Rev 12.fTf Previous eclfbons are obsolete. DESIGNATED FACILITYTO GENERATOR <br />