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Re a&• ,,Pa.(Fc-r de5.Q nod far up.on e:its(12-pitrh)typewriter.) Form Approved.OMB No,2050-M <br /> 2 Pagel of a.Er-!-plcy Revame Phone 4.kanifatlmddN Nmbar <br /> WASTE MANIFE L C,-r: "L E, -1 r- - <br /> J <br /> Li i r3 s <br /> UNIFORM HAZARDOUS ki, -LO JK <br /> 5.,Gew*es Hum wo 14dingAeliltm GNhwaWt,Skit Address(J dAnWtimn rra&g address! <br /> 6-riu3Wer I Company Name U.S.EPA F0 Nurmbec <br /> 7'%9',,. vr 2 Cmnpapy Kwrke U.S EPA1DNu-r.b-j <br /> 0.00gnaW Fa"Nam*and Sile Addiess r 1J.S EPA 10 Nw.bw <br /> `361rv5pmm.Sl' <br /> 9, gb.U.S.DOT Dwrom{IXudtrrg Proper SNppirg Nwm,Harm Cissa.K)Nurbv, 11.T-3t2J 12-UnN <br /> iiM and Pad&q QoW(9 any)) N ire Qmnuity WUVDL 13-Waste Cedes <br /> rC <br /> �clb G <br /> 7 <br /> 3 <br /> !L <br /> 14 Speaal Hardev kmtvctoDn6 and A44*wal Intomatm <br /> ;r <br /> 4T <br /> G CERT19CATION:I Naby dedam that&owlanti of this mmormrA m hffy and a=*Wy duwW abov9 by bho V"(gh'PPNr&rQr 2t-d are dasV.-J.paa.l} . <br /> ffpiwd mid bbd&d*csjd&d•and am In all mp6lb in proper w4i6on 1w rarmW wDx&g iaapoim*InWmtxnal and rA"govemrirtmW r"ka.K expor.0*xnenl.and I ari the Primary <br /> EWwr.I ow*UW tho mrtapts d tis cmAmord ocnkffm 0 the tom cl tm iitlached EPA of CortsenL <br /> I fie*41st te wage abWwAmd i JonhfiW in 40 GM 262,27(a,M I irn s Large quanly Vmrmofj or(bffl a$md qLap*gamrv! .'rue. <br /> GemrWTemrla PnjmdTypW Hamm Rrawne f monm Dal Year <br /> VT A—L <br /> -i IE lilt"25mi ShrpmInts <br /> El Import b u.S. El EKM Ir.U.S- Pot at eAlryiNk <br /> Tnpn9K lor s4mium(W exports orMi vale leavbv U.S.: <br /> 17.7resp0rWAckA0WWgmmt d RODW of RaWLaIs <br /> 'rranspCrer 1 I'linlad rTy*Hwne .5;gnaluri Moo Cay Ye 3, <br /> 0 <br /> Tran4tftr 2 Pm*cVTyW Harr* 5"K.-e Aknih Day Year <br /> 18 CisCrepjncy <br /> IS&04n7m kda"Spacip ❑ clumily [:]Typ. 1:1 RmA. EJPuFU REjuc6an 1:1 FA Rjcd <br /> Mande3.1 Reluence Name <br /> I 5z Amemaw FacRY(or c4mrjwf) U.S.EPA Z Runt& <br /> L<L Fa:.!h Plane: <br /> 1E:S 4-0:Lre of Aum a,@ Fadf:ly(cc Grwaby) Mc'Lk Lay Yca, <br /> 19.Ka.-I,jous Waste Repan Ma mgarml Mabod Codes CM.GO&Sbr hUard:)'-1 waste TeatmwL dswsaJ,arw mysing systems) <br /> r <br /> T <br /> 20.DasquA Faokt Owner or Opomw Cwgcvtko of raps A cd hamrdous n aleiiias ojymed by to ma&st excapl as raced ri:torn Hk <br /> Pert wey—pea Nwim <br /> mwm Day fear— <br /> EPA Form 8700-22 fRev.n5) Previous odii1cm amlabsdele DESIGNATED FAC]UTY'S COPY <br />