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'�� 1111111lIIIIi111I1111111111illllllll <br /> print or type.(Farm designed for use an elite(12-pitch) 0 0 6 5 1 3 8 7 3 S K S <br /> I P typewriter.) FormA roved.OMB No.2050.0039 <br /> n UNIFORM HAYARp0U5 7.Generalpr ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manhasl me tng Number <br /> I WASTE MANIFEST 2- 006513873 SKS <br /> e- .Generators Name and Melling Address Genermors McAdamom,il di8emnt than mailing address) <br /> Genemlor's Phone- <br /> 6.Transporel I <br /> hone:6.Tmnspoderl Company Name <br /> ' - U.S. PAIONumber <br /> 7.Tmnspoder2 Company Name _ U.S.IPA 16 Number <br /> B.Designated Facility Name and SiteAddmas <br /> U.S.EPA ID Number <br /> Facili s Phone - .. <br /> 9a. 91).US DOT Oascdption(ioduding Proper Shipping Name,Ha.,d Class,ID Number, igContainers <br /> HM and Packing GroUp(geny)) . 11.Total U.UNt 13.Waste Codes <br /> No. Type Ouantity WWaI. <br /> r) o <br /> C7 <br /> 3. <br /> 4. <br /> 1�4�3pedal Harbling rsuUdimserdAtldnionet ntomstion <br /> 15. GENERATGRtOFFERDR'S CERTIFICA71fNt;l lrerabyderlara met me mntenls of mN mrs(gnmenl am fully antl aocvm deserted�go"is 8tar <br /> marked and labdedlplacaNed,and are in all inspects In ' Y Pmperahlpphg name,arH am dassitied,packow, <br /> Proper condition for trarspxt according to applkable infema8onotand national govermtentw regulations.N skood shipment and I am Bre primary <br /> ExpglaA I ceraty that dta contents of this consignment conlonn to the arms of the attached EPAAckIMIC1gment of Consent.. <br /> (wrldythatgmwasmmmlNmbonsmtementidengfied In 40CFR 262.27(a)(Iflam a large quardi"oneetor)or(b)lift am 11 quantity generator)of but. <br /> GentatorA0fames PrmIVNyped Name Signeto <br /> � MOA Day <br /> 1 9Yeappr <br /> ; 16.Inmmegonai Shipmems lid 4C <br /> }! }p <br /> t� ❑Mpal to U.S. QExpartbom LLS. Pod of enuylexit:_ <br /> « Tmnsponer slgnemre(foray ms only): Dale leaving U.S.: <br /> 17.TrampDrlarAcknowleoment of RamIPI of Materials <br /> O Tran e 1 pdnledyfypme Signa I <br /> „Ma�n{tlr Oe�y7 Year <br /> Ton dnfe Ypad Name <br /> a 81 tum ' ,y Mama Day Year <br /> 18.Discrepancy ^ `''�`? t�I/ Y <br /> 18a,DIscrepany Indication Space LJ Ouenaty ❑Type ❑Residue <br /> ❑partial RejeeBon ❑Fug Rejecdon <br /> 18b.Alternate Fadgty(or Germreia) Mard(esl ReterenraNumber: <br /> rr U.S.EPA ID Number <br /> u Fadifty's Phone: <br /> 18C.Signatureof Itemate Faclity(pr Generator <br /> � Month Day Year <br /> �!8r29 19.Hazanlou Waste Report Management Memod Cedes(i.o.,codes far hozardous waste keaimenh disposal,and reujmling systema) <br /> i <br /> rant Facility <br /> Pd ameams• trw+mro Opomtor.CediBaagon of oslpiothazrdwsm8tedalsmvemdby Uvmanffestexw as in It 18 <br /> Sbnatura <br /> a <br /> EPA f0rm 8700-22(Rev 3-05) Provlous adi0onsare obsolete. DE IGNATED F I O ESTINATION STATE(IP pEQUl ED) <br />