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,4 760 R�= <br /> Pleas t or type (dorm designed for use on elite(1,2-p1t9h)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 G,enerator.ID Number' £ 2.Page 1 of 3 Em@rggency Res o, ,", 1.4.Manifest Tracking Number SKS=Ei ( t�I a�Z, ! ,, 4)(3 a f 7.o t (F SKS; <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address" Generator's Site Address(if different than mailing address) <br /> Rd At tyl &muel Nch ywt k 2 � 'r. ' r��d F <br /> IdAl L ` 1j 'Sr r acTr r t.tag `grit <br /> T RAC T <br /> Generators Phone: ' <br /> 6,Trants�oorPierl Co pa a4mge U.S.EPA ID Number <br /> E '�i� !`t: tIk�1 �II, t A.4�t'tdlet#?1.f`i_rr L <br /> .. o ' <br /> 7.Transporter 2 Company Name U.S.EPA ID Number, <br /> 8.Designated Facility Name and Site Address SAVETYi W- LEE I.4 S'�;�T l 8 r ( U.S.EPA ID Number <br /> � '' 88TH STREET <br /> Y 16—306-4913 <br /> Facilitys Phone: _ <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM land Packing Group(if any)) No. Type Quantity Wt.Noi. , <br /> maw-- "qtr 1AA-ZARiD01,12i WASIT, LIMED 1?° t j X114 <br /> (NUEOW PARTS WASHER SOLAITION) <br /> z 2. <br /> LU <br /> O <br /> 3. <br /> 4: <br /> 14.SpecralHandlinglnstructionsandAdditionalinfo rmation �rce$rtc hof} .i• 1ttdZ MID: 21A <br /> .r+ <br /> l b <br /> riff'rM. A.:' N— e I"t,f—r e." y GIV14 1,11 <br /> .T T I T S1F 2'B <br /> 8 fi;s"d"�' f fi .r'Y 14". «a - <br /> 15. GENERATOR'SIOF,FEROR'S CERTIFICATION: II hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this;consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that,the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifi am mall quantity generator)is true. <br /> Gene ratorslOfferor's Pnntedrrypea Name Signature Month Day Year <br /> vli <br /> q t'e <br /> ­--ZLA, <br /> . international Shipments • / Port of ert <br /> ❑Import to U,S. Expgrt from U$ rylexit <br /> ..r <br /> Z Tfpnspptler signature(for exports 0nl): .-; awing <br /> Date ie <br /> W '!I-rra6s0od6r Acknowledgment df R$ceiptb MateHrals'' <br /> Transporter 1 Printed/Typed Name Signature r Month Day Year', <br /> O <br /> 10- <br /> 0) Transporter a am Signature" , Month bay Ye r e <br /> F- <br /> 18.Discrepancy . <br /> 18a.Discrepancy Indication Space Quantity ❑Type El Residue El Partial Rejection niull Rejection <br /> Manifest Reference Number: r` <br /> S <br /> 18b:Aiternatefacility(orGenerator) <br /> EPA IID <br /> L) <br /> LL Facilitys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 19,Hazardous Waste Report Management Method.Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> oL , 12. 3. 4: <br /> J j'v <br /> 20,Designated Facility Ownerr Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a ; <br /> Printed/Typed Name /J /f// : rr Signature /P� r Month Day. Year <br /> EPA Form 8700-22(Rev.3-05) Previouseditions are obsolete. DESIGNAT8 `'FACILITY TO GENERATOR <br />