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1 .. ii$ : 'ti e'er 9` -36,i; r <br /> Please print or,type,(Form designedsfor use on f4te(12-pitch)typewriter.) Form Approved:OMB No.2050-0039 <br /> S 1,GeneraiorlD Number C 2.Pag 1 of 3 rem Ro se q e 4.Manifest Tracking Number <br /> UNIFQRN"N RDOU <br /> wAsrE.MANIFEST <br /> : SKS <br /> 5 Gener Name and Mailing Address' _ Generators Site Address d ddferent khan mailin address) <br /> ( olden e <br /> ft W s f R A '. . . I'' ford <br /> "fry A' 95377 Attu life F. . <br /> GeneratorsPhone: "` 9,14 TRAC. �i� ` `3 1°"`97158, <br /> 6.Tgffig o n �� U.S.EPA ID Number <br /> WO s Tx <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8:Designated Facility Name and Site Address SWETY—KLEEN OF CAS„TIFOR I A U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> "'" WAR r <br /> 51 '75" .� i 741 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12:Unit" <br /> 13.Waste Codes <br /> HM" and Packing Group(if any)) No. Type Quantity Wt.Nol, <br /> ?- °- CRA HAZARDOUS WASTEv LIQUID' TT 225! <br /> o (MED OILS o C7 <br /> � <br /> w t: <br /> 4. <br /> 14,Speo Handling instructions andAdditional Information TSW EVA ADRO198 CM e <br /> P-4°11RY I 8 <br /> -461760 ( 1? <br /> 7 TF <br /> 1 ITf . "AGENT-FOR': Y: N T R TARN LICENSED SUB RRI R A9 ICY <br /> 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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemation and national governmental regulations.If export shipment and am the-Primary <br /> Exporter, certify thatthe contents of this,consignment conform to the terms of the attached EPAAcknowledgment of C ant. <br /> I certify that the waste minimization,statemenl identified in 40 CFR 262,27(a)(if I am a large quantity genera r)or(b) I am a small quantity;generator)is true. <br /> Genera 7slOfferors Printed ped Name-- Signa Month Day Year <br /> J 16.InternationalShipments <br /> H El import to U.S. ❑ xport from U.S, Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17_Transporter Acknowledgment of Receipt of Materials <br /> T anspoter 1 Printedfrype Vame gnature Month Day Year <br /> IL M1 <br /> rt <br /> aTrgnsprtM Printedffyped Name Signa u Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space quanti <br /> ❑Residue jection <br /> Quantity Type Partial Re Full Rejection <br /> Manifest Reference Number. <br /> 18b,Allemate Facility(or Generator) U.S.EPA ID Number r . <br /> CV <br /> ua- Facility's Phone: , <br /> W 18c.Signature ofAlternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1. 2 3. T4. <br /> O <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted 16 Item 18a` <br /> Printe ped Name Signature Month Day Year <br /> EPA Form 8700-22 JRgv.3-05 Previous'editions are•obsolete. DESIGNATED FACILITYTO GENERATOR <br /> 1, 4��� <br />