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Please printor type.(Form designed for,use on elite(12 pitch)ty ewnter.:; Form Approved.OMB No.'2050-0039 UNIFOp ' AZARDOUS 1 Genera or ID Number a .x 2.Pag 1 df' 3 Emer e y spg se Ph qe 4.Manifest Tracking Number $TEMAN(F�sT .t �3 � . 0064 883 S. S 5.Generator's Name and Mailing Address Generator's Site Addressrf different than mailing address)"411 L - '04 @��'� s'a�a 'gild d A't n Satr�.�e VIC11f.rtf's� 18i'Cj� '81 ��f�� rE 141 Generator s Phone: ` RACY G 5 z rt s mp a=�.. 5�� .M I't's ,, U.S.EPA ID Number s ril v(1� f rfi?" 7.Transporter 2 Company Name U.S.EPA ID Number d 8.Designated Facility Name and Site Address B.n r k . SYSTEMS T NC U.S.EPA ID Number 60 );) i`t i *EET SACRAWNT 4 t,A91& 3@6 40MIJ Facility's Phone: ga -` 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers11.Total 12.Unit: 13.V49ste Codes HM and Packing Group(if any)) No' Type Quantity Wt,NoL: z z. W 3 l 4. 14,Special Handling Instructions and Additional Information f,r 1�5C:r-s r5 7 E.57 9 Ar)i°o-I v,e 'n0 rmw; 24 t7r-,'Wt.,Y a 01 0 00-468..1.760 f Si'r1 Atar P1 AS }'A GEt�4f;- F R� .B Y E_;EA,h TO N E i'AIN L ICE14SED t I U P F, RR4KILt4 As NEfA r19AC F?'r 15. GENERATOR'S/OFFEROR'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, marked'and labeled/placarded,and are in all respects in propercondition for transport according to applicable'international and national governmental regulations.If export shipment and 1 arr the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consen. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(' a a small quantity generator)is true. Generator's/Off is Printed/ryped Name. Signature' Month Day., , Year 16.International Shipmen H El import t U.S. ❑Export from U.S. Port of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials TransWrtePl P'ntedlTme Signature `" Month Day Year s CL zUL _ T QTransporter 2 Printe yped NameAa� �_ Signature Month Day Year Q F- 8ft2 i rscrepancy 18a.Discrepancy Indication Space El quantity Type n Residue El Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID NumberIt . J s, W Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q 4. z N 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G' 1. t41 2. 3' 4• 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials'covered by the manifest except as noted in Item 18a in TeNa,,rt �a St ature Month Day Year EPA Form 8700 2 Rev 3-0�) Previous editions are obsolete. DESIGNATED FACILITY TO GEN ERATO