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K SHIP# c` I IIII II�III II '(I�II III I II��I <br /> 007477025SKS <br /> Please print or type. Form Approved,OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number T Qy,, 2.Page:1 of 3.Emergency Response Phone- 4.ManOifest Tracking t�umber <br /> WASTE MANIFEST 0'747 <br /> 5.Generator's Name and MarlinIo Address Generators Site Address(if different than mailing address) <br /> 'AL 7 - CA <br /> Generators Phone. ?Q?-5§5-11_.11 <br /> 6.Transperfer- fomp3ny-tJarpe YSTEMS INC U.S.EPA ID Number - - <br /> 7.Transporter 2 Campany_Name U.S.EPA ID Number <br /> _ rNV 7VC INC. <br /> B.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 12533 BE CARPENTER DR <br /> CI-ACKAMAS CIR C1701F--8988 <br /> Facility's Phone: <br /> its. 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10-Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Typo Quantity Wt.Nol. <br /> 1. -. <br /> 0 <br /> a�a <br /> W <br /> z 2. <br /> W <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information _ <br /> 1=ERGENCY#800-46--1?t CH 5".JTE,-C+,::t:^-ci r stainlld by gener.ltor confers agency aatthrr=: <br /> tin;, tr•ar,gporl �r +,e aict or sr?bstit !te additi-::,n+1 fr 1 rt r= ne;,tn;,= `eF•-1f <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassitied,packaged, <br /> marked and labelediplacarded,and are in all respects in proper condition fortransport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> certify,that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator or b)(if I am a small quamd enerator)is true. <br /> Genaratorsl0fierors Pdntedlf p d Name Signa V Month Day Year <br /> IIPE(1,2 to1,io <br /> _J 16 International Shipments <br /> !- ❑Import to U.S. ❑Exportfrom U.S. Port of entrylexie <br /> E Transporter signature(for exports only): Date leaving U.S.: <br /> W 17,TransporterAcknowiedgment of Receipt of Materials <br /> Tra orter 1 PdntedTyred Ala�pe/r ^ _ Signature Month Day Year <br /> a 11�A111']L4t�iC:Jvx`G -I7 <br /> ZTranspoA Prinddt[Typed Name Signature ` Month Day Year <br /> 1a.Discrepancy <br /> 18aDiscrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> >- 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> I Facility's Phone: <br /> Ujj 18c.Signature of Alternate Facility(or Generator) Month Us, Year <br /> zz <br /> y19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1 1 L 2. 3, 4. <br /> 20.Designated Facility Owneror Operator Certification of receipt of hazardous caterers covered by the manifes xcept as no( in Item a <br /> Prinledliypetl Names Sign ure M h Da Year <br /> `/✓ <br /> EPA Form 8700-22(Rev,12-17)Previous editions are obsolete. SIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> Page 18 <br />