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Please print or type.(Form designed for use on elite(12-pitch)typewriter) <br /> Form Approved.OVIS No.2050-0039 <br /> UNIFORM HAZARDOUS 11.Generator lDNumber 2.Page 1 of 3.Emergency Response Phone4.Manifest Tracking Number <br /> JJK <br /> WASTE MANIFESTR '1-i <br /> e4 <br /> -Q-4 r-1; <br /> 5.Generators Name and Mailing Address Generators Site Address(If different than mailing address) <br /> r4,;/ TW ,1 T P A V Fi r P :AZA f Rf,F,VV A9 AJ, 'F 'I Of" ff. �'�K-RKTrw R T, <br /> 7"N TNG J# 61700 5 <br /> F T,UP V-1 i7,".-1`I 1.GD T A ��-j <br /> Generators Phone: 5F8-7 449,51 <br /> 6.Transporter I Company Name <br /> U.S.EPA ID Number <br /> k-AIJVORKTA SRRVTORUR 000VII CAR0,00I... --�023 <br /> 7.Transj)orter 2 Company Name <br /> EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.-EPA ID Number <br /> "'000 NOR114 UAWMA ,;T, 0-441 P-11101 CA 9(7, 7 cJc <br /> Facility's Phone: .31 0-5: 7-7';00 1 (7 ?. T 0 S 0 0 1 -3 .3 i 2 <br /> 9, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 10.Containers rs11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type <br /> Quantity Wt./Vol. <br /> 0 cc I aHca'}.i kc'TRI T A K11 R T F, I If 1T T) N 0 <br /> Y,-I N-R T')T T <br /> W <br /> 2. <br /> lJJ THIS WASTE STREAM HAS BEEN QUALIFIED <br /> FOR RECYC1JN"G/-'I-'RFJ'ATN1E-1N'TZ')AT [HE <br /> 3. <br /> rPNECAL! Th- CESSARY t <br /> PERMITS TO REMFIV'r YCfl 12 WASTE STREAM AS <br /> 4. <br /> QUALIFIED.OUR EPA NUMBER IS CAT080013352 <br /> -14.SAT-I Hanciling Instructions art.dAcldhlonefl.lnformaton <br /> TDTT;,'M4,<-1 APPR..- !;WATAPO R T A" 1-( <br /> KP i R <br /> 74 THOUR PN7, PG'FNC%' CAONTACT- <br /> ('$Pqw,T7'R'RC AAO-424-Q-,00 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and laboledfplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.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 certily,that the waste minimization statement identified in 40 CFR 262.27(a)Cd I am a large quantity generator)or(b)(if I am a small quantity-generator)is true. <br /> Genwfors/Offerqrrs Printed(Typ9cl-Namelure Month Day Year <br /> -J 16.International Shipments <br /> -1 Import to Port of entry/exit: <br /> F U.S. E]Export from U.S. <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> 17,Transporter Acknowledgment of Receipt of Materials A <br /> Tra <br /> Pfinted/Typed Signature Month Day Year <br /> 0 <br /> Z Transporter 2 Printed(Typed Name Signature Month f Day Year <br /> F- <br /> 18 Discrepancy <br /> I aa.Discrepancy Indication Space Quantity EIT p. El Residueli El Partial Rejection El Full Rejection <br /> P <br /> o b�,(' <br /> ncia ber� e- <br /> 'n cc In OP ad Mani*WefereNum <br /> 18b.Alternate Facility(or Generator) -L-- <br /> U<- Facility's Phone: <br /> 0 <br /> LLj 18c.Sgnature ofAftemate Facility(or Generatoi) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(.e..codes for hazardous waste treatment,disposal,and re-cycling systems) <br /> on <br /> w 2. 3. 4. <br /> L 20.Desig"ted Facility Owner or Opera! -Certification of receipt of hazardous materials cavered by the manifest except as nqM-in Item 18a <br /> PrintodfTtNlame Signature Moo Qay—, Year <br /> 3-4 <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> DESIbNAT-EdFACILITY TO GENERATOR <br />