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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number I WASTE MANIFEST '� '?4 i2 v' " ''"`' ` 020319603 JJK 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) At4I V1141IriI I KtiWof -All`#iV:l06- Generator's Phone: i epi71�;0ria , tis a 6.Transporter 1 Company Name U.S.EPA ID Number lirr # ?.rs"„�r r9u�jJl�Pl�i`BI#t#. .I't'ifli�e�:a 7.Transporter 2 Company Name U.S.EPA ID Number vv,i-LL av 8.Designated Facility Name and Site Address U.S.EPA ID Number z: iltitt#rhi��fYti�4'r.ii�s;. r sa6 f pkt,-j fit Uairs _ aaa AZ.R()UG°921. 14.16 Facility's Phone: 'v..:F3/:44-ZGr u ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1' 34td3#t.a�sui i Narii'd1i3tda aditiriS. Xti.ili 4i1a tP(t.i"5a'Ltt 3#iia , O Q - w z 2. UJ c7 3. 4. 14.Special Handling Instructions and Additional Information t..410s`�,:, ,.1 >`vd !,c..di�di.vs.'ait`R�t'sljfif't"L .tal' Tilt. i#d(�!4ii#1xi. I" Ib.f}:. 's.ra 3" tti ii<..im 3} £3..t...i.:x�..iloi#ar:..:t4i^F-� k_,iJJ 3 {tZ fL3: t?t#'t4it 13I I t:it s t 0 h°I ttJI F#?t D P"# t jl3ii I fk i11 - k �4 15. GENERATOR'SIOFFEROR'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 international and national governmental regulations.If export shipment and I 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)(ifI am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU Transporter 1 Printed/Typed Name Signature Month Day Year Oa Z Transporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. 4. a 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY