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Please print or <br /> type. <br /> UNIFORM H 1.Generator lD Number JUNNI <br /> AZARDOUS 2.Page i of 3.Eme Form Approved.OM;B No.2050-0039 <br /> WASTE MANIFEST (qj y� fly:, rgenoY Response Phone 4.Manliest Tracking Number <br /> 5.Ganerators Name and fill Addl {_7F t <br /> ;a rl t tl R BOO� Generators Site Address(if different than mailing address) FLE <br /> Y 4Jark= 6.,5 <br /> Body (tia <br /> r.3ttl- i,, fir) r y rks#b� <br /> Generators Phone: c.._ _ , .R1.�7P 1 t_,_.! St-;^,f;l.= E �::. r ..�*.- <br /> I f)(.:) tlhl, r g r;'I]l! PI'S �lI i f 1c, <br /> 6.Transporter 1 Company Name • <br /> "T1)(1V Tot` <br /> ;0eC;z:tt, WaS f, U. .EPA IDNumber <br /> ].Transporter 2 Company Name t e '=1 r•1}=t?`i S T n r <br /> I+'AI^fh�lA 1 109k <br /> r)nl^%Litrlj.ffP j2nf:`aVet^ U.S.EPAIDNumber <br /> 8.Designated Facility Name and Site Addres. `� stems <br /> Cf� s?rl' 1•- ,y.-.._, <br /> 14 <br /> 3t h Street U.S.EPA ID Number <br /> FacfitysPlro ."oAE•1, yt,i1'�T `1y7. f1�,-6!5 <br /> =11�?,Et <br /> 9a 96.U.S.OUT Description(including Proper Shipping Name Hazard Class,ID Number, f c - <br /> HM and Packing Group(it any)) 10.Containers <br /> pari 11.Total 12.Unit <br /> RCRl1 ha2af,dous teas No. <br /> Type Quantity "0 1. 13.Waste Codes <br /> .0tions)y te, liquid (5tiaf sa <br /> W lhkl i:i1C7 j-' ver l <br /> W 2. <br /> t,7 <br /> 3. <br /> 4. <br /> 14.Special Handling InsWq ons ORR Iddl: inal Information, <br /> ,. j.ft�90�(8tate Re�)r.11.ai:er I..:iyr.tids} , <br /> 15. GE ked and abeled FEROR'S Cnd areCA I hereby declare that the contents of this aonstgnment are tu8y and accurately marked and labeled/placarded,and are In atf respects in prefer camdiLon far bans <br /> Exporter,I certify Brat the contents of this cons _ Y descr bed above b the proper shlpptng name,and are doss fed, <br /> conformto <br /> the le s ofPart according to applicable intemationalandnational govern n packaged, <br /> I cert fy that the vrasle minimization statement identified in 40 CFR 262.27(a}(d Ilam t a E�anAG figment of a L u�gons.fie <br /> xport shipment and i am the Primary <br /> Gen ors/QRerors Pdnfed/Typed Name largo 4 lygenerator)orjb dl a sma0 quan' <br /> Sfgnatu 9 erator)Is Ini <br /> 16.lntematvnalShipm is <br /> vt/( A-rk - l R'L r e P a e h 1 f r,f L i nv i t e 0U' DaY Year <br /> = TrpeEl Import to U.S. <br /> oexportsortly): IAF c <br /> ❑Export from U.S. Pon f entry <br /> w 17,T-ePorterAcknowfedgmenl of Receipt of Materials Dal teavi <br /> OTransporter 1 Prink d(iyped Name <br /> vat nt"' 11"' iYiarj•f Si atu <br /> Z Tr .ergprint yped Nae 1 of Month Day Year <br /> ►- �� Sig -.-. <br /> 16.DisaepanoY Month Day year <br /> 18a.Dsaepartcy Indication Space Elantity Q r <br /> Qu <br /> TYPe ❑Residue <br /> ❑Partial Rejection <br /> 18b.Alternate Facility(or Generator) ❑Furl Rejeulon <br /> Manifest Reference Numbar. <br /> U <br /> Fadfity's phone: U.&FPA ID Number <br /> LL <br /> u 1ga-Signature of Altemate Facility(or Generator) <br /> Q <br /> Z <br /> V5 19.Hazardous was Report Management Method Codes p.e.,codes for hazardous waste treatment,disposal,and re MOn� Day Yeaz <br /> 0 1. <br /> 2. n9 systems) <br /> 3. <br /> 20.Desi 4. <br /> grated Faatity OwnerorOperator:Cerofp6on of <br /> Printed/Typed Name fece+Pl of hazy dous material covered by the manifest except as noted in Item 18a <br /> PC Signature <br /> EPA Form 6700-22(Rev.12-17) Previous editions are obsolete. Month Day Yeppar <br /> �� <br /> O <br /> DE I N ED FACILITY TO EPA's E-MANIFESTSYSTEM <br />