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Please p6rill or type, ForMAPPUA.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 11 Generator 11 Number �4.—ManifestYracking Number <br /> 2 Page i of 1 3 Emergency Response Phone <br /> FLE <br /> WASTE MANIFEST 10146 585 17 <br /> 5.GenewYs Name and K%lin'Address v, GewatYc Site Address fif diftreil llriaii matiw a,1Ars,--j1 <br /> -7 <br /> GenecfflVs Pftm- <br /> 6.Tranpoll(q 1 ComWy Nam U S.EPA ID Number-I IC I I <br /> 7 lean miler 2 Cmwy N— U 5 F51A ID Mimbo <br /> 8 O"nakd Fdvrtity Kam.and SilaMresa U.S.EPA M Number <br /> L 2,`Jb H:f-E LU C-�1, 3 <br /> Fao4ys Phone: 7P Z R 0 0 0 5 2 0 <br /> ga, 91b U S DOT Description(inducing Proper Shipping Name,Hazard Class,10 Number, 10,Containers 11 Total 12.Unit 13 IVasle Cc&- <br /> HIM and Packing Group(if any)) No. Ty; Quantity Wt ivol <br /> IX <br /> 601 l cxvF, <br /> M <br /> Z 2 <br /> LU <br /> 3. <br /> specal Hard g IwWk2r*aTA Wkteal Infor-to, P 0#E`')S 1 84 W.104 r 9 d95 B I ILL E C P U <br /> 15 GENERATOWSMF FERORrS CERTIFICATION:I hereby declare that the contents of this-,,w§ji:m4T are fully and accurately described above by the proper shipping name,and are classified p2claacd <br /> marked and labeled/placarded.and are in all respects in proper condition for transport according to applicable internattonaland national governmental regulations If export shipment and 4 am the rnniaiy <br /> Exporter,)certify that IN 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)(it I am a large quanblygenwatw)or tb)(ifl am a small wVqq(oM'aW)is true. t <br /> 16 lute"b"n"SJ"' O's Li import to U s Export from U S Port of entrylexil: <br /> Tr4rdpodel signature floc exports only): Date"mag U.S <br /> 9Z 17.Transporter Acknowledgment of Receipt of Materials ------ <br /> CY <br /> PnnnTedfT);xd Name <br /> C, E' <br /> U) <br /> Trv%sWWr 2 PnnrodplyW N&.w <br /> 18 Discrepancy <br /> l8a Discrepancy Indication Space El Quantity Type Residue Partial Rejection Fdl <br /> M,jrHfesi Motv.nr#Number. <br /> 18b.A.Itemate Facility(or Generator) U.S.EPA ID Number <br /> L) <br /> I FacwtVs Phone: Mcnth Dar Yeas <br /> w iBc.Swjt1ature olkilaimile Factlity[or G+!rwralo-rl <br /> Z <br /> 19,Hazardous Waste Report Management Method Codes(ii e.,codes for hazardous waste treatment.disposal.and recycling systems) <br /> 0 <br /> UJI 1 1 3 <br /> 20 Designated Facility Owner or Opmlu Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pro,w4yi*d Name sln,31trE M"!91 b.k, <br /> EPA Form 8700-22(Rev.12.17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />