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r)TCf- 11.A1 1 P,'?fl pp- Please print or type.(Form designed for use on elite(12-pitch)typewdtet) t;7 t ^.��.•;ti_�,^ :��;,. •; ,1 ""'" Form Approved.OMB No.2050-0039 1.Generator ID Number 2 1 of 3. en Res Phone 4.AAanifeat T kin umber F L E UNIFORM HAZARDOUS � � � �__� 0 0�8�8 8 4 9 WASTE MANIFEST' r, ,.ti ,.,_ ' � ,�- ; _ _ 5.Generators Name and Mailing Address - Gerwators Site Address(if different than mailing address) i? 3SY�C%!Sc'Avenue Generators Phone.--n nr-.- n •r r rz 6.Transporter 1 Company Name U.S.EPA ID Number -i)1`171•x•' 1'.;W7:-r.711,•:1a:.?a+7 AP7ta^? '�� ••• n ^+.r+ s a a 7.Transporter 2 Company Name U.S.EPA ID Number- - 8.Designated Facility Name and Site Address U.S.EPA ID Number ,r"•��r rsrs f3utton;Tow LEC West � n �r� r3: Jr' E,9- 7 j F i s'Ptlone gill. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packjng Group(if any)) No, Type Quantity Wtivol. 13.Waste Codes 1. p XMM-PCR;9'",AZA RD, U-5; UA-3'E-C;0I_iD�';.M U 7E'iCA'AE a z. W 3. 4. 14.Special Handling Instructions and Additional Information 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 proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and 1 am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true- enerators! erors Pnntedrryped Name bignature Month Day Year Pk u 2 / 7-LIZ J 16.International Shipments F- 014-rt to U.S. [:]Export from U.S. Port entrylexit: Z Transporter signature for exports only): Dale leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials 11- Transporter 1 Printed Tp Name big Month Day Year ZQ Transporter 2 Printed/Typed Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA ID Number J U Q LL Facilitys Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a z to19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ) w 1 2. 3. 4. 20.Designated Facility Omer or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedfiyped Name a Signature Month Day Year "z 112-1 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DE NAT F CI TO DESTINATION STATE(IF REQUIR D) =a Vii:.:;:,5 .�y..,a�.;p,_;.:: :�..s':..� 12556.1994,;JB':?1}e'a-�:z�c: 3 -;.