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SK rbHIP# 2��R?97444 <br /> Please print ortyp.. Form Approved.OMB No.2050-0039 <br /> 1.GeneratorrD Number 2.Page.1 of 3,V esponse F�hon�,-.,, 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS me <br /> A <br /> SKS <br /> WASTE MANIFEST <br /> 5,Generator's Name and Mailing Address Generator's Site Address(if different than mai-ling address) <br /> 71. <br /> Generator's Phone: <br /> 0.71"ij?XAR —� U.S.EPA ID Number V <br /> — 7,t) <br /> 7.Tranp"r 2 Cdmpany Naffie U.S.EPA ID Number <br /> HARBORS EMV SIX. 1NC. <br /> 8.Designated Facility Name and Site Address <br /> U.S.EPA ID Number <br /> :J <br /> Y <br /> NE.D98172,35i.7i <br /> J <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Descripti6n-(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI.Nol. <br /> 741 <br /> D14 P <br /> FREON <br /> 0 F-'- T <br /> A <br /> O <br /> 3 <br /> .4. <br /> 14,Special Handling Instructions and Additional Information 711-0, <br /> 0J.) <br /> P414 retained by generator cunfers agth <br /> envy auori ;y <br /> 3n initial trans pDrtpr to add cir suhs' ikute additional transporters on genera or's behalf. <br /> 15. GEN ERATO R'SIOFFERO R'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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Genera tor's/Offeror's Printed/Typed Name Signature Month Day Year <br /> _j 16.International Shipments <br /> El Import to U.S. ❑Export from U.S, Pdn of entry/exit: <br /> K Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> F— Transporter I Nn yp Name Signature Mwb121 Day Yee <br /> 1 <br /> 0 <br /> CL <br /> ZU) <br /> TransporteFZPrinted/Typed Name Signature Month Day Year <br /> tr <br /> t8.Disopancy <br /> 18a.Discrepancy Indication Space El QU2 tity 1:1 Type El Residue Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Cenerator) U.S.EPA ID Number <br /> 0 <br /> LL Facility's Phone: <br /> Lu 180.Signature of Alternate Facility(or Generator) Month Day Year <br /> 0 <br /> Iq 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> ll. 1 2. F 1 4- <br /> Ll20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Slignature Month Day Year <br /> EPA Form 8700-22(Rev.12-..17 GENERATOR'S INITIAL COPY <br /> ious editions are obsolete. <br /> J <br />