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1" Form-Approved.OMB No.2050-0039 <br /> Please print or type:(Form designed for use on elite(112-pitch)typewriter,) :;,;:r, ;�..:....�`,';,°„.:;'.4.i...,, .' <br /> 11.Generatollmber 2.Page 1 of 3.Emergency Response Phone 4.h1.nifesI Trackin Number <br /> UNIFORMH4ZARDOUS , �; A00 4 JJK <br /> WASTE RANIFES� r 'r; 9 4' i d2 4�0�? <br /> 5.Gig�ip;'t,Nagffid.MaiIiN"115 Genoratol Sile Address(if different thamfnailing address; <br /> XINTMER Irdd, <br /> Generator's Phone: <br /> 6.Transporter'1 Company'Name ' U:S.EPA'ID Number <br /> A-'`"+Sti`JA f : i4. 'I I 0 z? <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> 8.De nated Fadiily a e and Slt ppoor ss U.S.EPA ID Number <br /> 4A.r:,ar <br /> { t 7 iii <br /> SOUTH B D s 7.,E 1'i,,EX j J}y <br /> LOS A311'�A't°.J)E2YR r..A p0i5 t4 C. A_Di 0 „ <br /> Faditys Phone' <br /> ga 9b.U.S.DOT Descrip8on(including ProperShfppIng Name,.Hazard:class.ID Ntmrber;, 1D..Cantairars 1.Total 12:Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WLNol. <br /> Ix tt(tXI rY yt. fI!, 7-.7 C}: T ..'`.r.��K r `! I.1D "(0.12'.SO1,11'` r ,j <br /> r <br /> W , <br /> W z. <br /> 0 <br /> 3. <br /> 4C. <br /> 14.Special Handlln8 Instructions and Additional Information <br /> jszj-{e�eF•f(? s',6t.'f.40A9TAZ?C' 4 -4. 4.43300VRk:2r, !�S'i 171 * 'E' rtP'ilr g7. . <br /> AlJ.4l . ^�' } F>k FFt: S�+.S � e 0NAL I TiC)�.�.T• i11 = <br /> tY ,a J.7',�1 FAa :1blJ.l 1 `Y <br /> 15• GENERATOR'SIOFFEROR'S.CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuraleiydescribed-above by the.proper shipping name,a d are classified,packaged, <br /> marked and labofed!placarded;and aie in ail respects In proper'condition W trahiport according to applicable international and.national govemmental regulations.If export shipment and Lam the Primary. <br /> E>Spotter,I certlly.thaClhe contents of,this consignment conform to the terms of the attached EPAAdmbwledgmenl of Consent <br /> I'cer(ffy;that the waste minlmtzatlon'statemerl identified in 40 CFR 282.27(@)(ifd aiti a large.quantity generator)oe(b)(if l am a small.quanliry generator)is truer I <br /> Cetyerator s106erors Pri t dlTypetl Name Signature Month Day Year. <br /> -J 16,International Shipments <br /> EJ import to U.S. ❑Export finial US. Port of antry]exil: <br /> Z Transporter signature(for exports only):.' Date leadkr U.S.. <br /> 9 <br /> w17'Transporterpc rowledgrp6iof keceiptbf Materials <br /> TranspogeY.1 Printedrryped Name Signature M,6nth Day Year; <br /> zr 44-- <br /> spoder 2 PrintedfTyped Name 4Big ialure hicnth Day ' Year? <br /> 18:Discrepancy .i <br /> 18a.Discrepancy Indication Space " <br /> uantity. Type ❑Residue. ❑Partial Re;ectien El Rejection Q <br /> Manifest Reference Number. <br /> 18b.Altemate Facillty'(or Gbnerator) U.S.E°A ID Number <br /> r . <br /> V <br /> LL Facilitys Phone: <br /> LU 111c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1. 2, 3. <br /> 20.Designated Facility Owner or Operator,.Certification of receipt of hazardous materials covered by lhe.manifest except as rested in Item 18a <br /> PrinledlTyped Name Signature g ! Month Day Year <br /> EPA Form 6700-22(Rev.1-05) Previous editions are obsolete. TRANSPORTER'S COPY <br />