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Form Approved.OMB No.2050.0039 Please ' t or type,(Form designed for Use on elite(12-pitch)typewriter.) 2 page 1 of 3.Emergency Response Phone 4.Manifasf Trackin Number , M HAZARDOUS 1.Generator ID Number SKS WASTE MANIFEST'' 5,Generator s Name and Mailing Address' }.. Generator's SiteAdQres(if different than mailing address) AbESA @0I "Oat e Rd R t C 5377t Tt y e?�U t r bb TRACY T 4 9537-7-57@6, Generator's Phone. " �'� U S EPA ID Number 6.'Transporter l Company Name ' SAFETY- L. M SYSTEMS INC U.S.EPA ID Number , 7.Transporter 2 Company Name 8 D 'Sig r'at d Facility`Name and Site Address �� WILMINGTON LLQ CLEAN 1'737 T LSE I STREET � � ILMINGTON � Faality's Phone: 10.Containers 11.Total 12.Unit U.Waste Codas ya 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No Type Quantify, WtNol. HM and Packing Group(if any)) a , 1 N N`"R Z OO STEL ID r -- �O � LILT ) Z 2, Uj �? 3 tl 4. Ce PC 14 Special Handling InstNctions and Additional Information Tel)g I 777 .g H m `NY� I„8 �� ®17thSK 3 �. 15. GEN ERATORWSIOFFEROR'S CERTIFICATION: I hereby declare 0iat the contents of chis consignment are fully and areal and atjorrale ova omentare gulabons.I'I shipping hipment and I esm the Pnmary marked and labeledlptacerded,and are in all respects in proper condition for transport according to applicable internatlon 9 Exporter,I certify that the contents of this consignment conform to the terms if I am attached cara qua Aty geneeato)or(b)(if I Se small quantity generator)is true. I certify that the waste minimization statement identified in 40 CFR 262.27(a)( g Sign lure Month Day Year Generator's/Offeror s Printetl/Typed Name J 16.International Shipments ❑Export from Ui3 Port of entrylexd. i z ❑import to U.S. Date leaving U.S,: Transporter (for exports only): W •17•.Transporter Acknowledgment of Receipt of Materials Signature Month. D �e Transporter 1 Printed/Ty ped Name O 401(u CNJ �- Signature Month' Day "` Year z Transporter 2 Print e d Name 18 Discrepancy 18a.Discrepancy Indication Space Quantity Type ❑Residue ❑Partial Rejection Full'Rejecocin Manifest Reference Number: U.S. EPA ID Number . 18b.Alternate Facility(or Generator) pa. Facility's Phone: Month Day- Yet W 18c:Signature of Alternate Facility(or Generator) Q z N10.Hazardous Waste Report Management Method Codes(l,e.,codes for hazardous vasie treatment,disposal,and recycling systems) 4 W 2 13:0 46137 i 20.Designated Facility.Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Month pa e< ed Name Signature t j '!9 iPrinted�rrJC, �t1 EP DESIGNATED FACILITYTO GENERA7i EPA Form 8700-22(Rev.3 05) Previous editions are obsolete.