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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUSlith erator ID Number -7 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C, ( ci 30 T' CC) -6-V -9 3 b 019 7 0 3 5 7 6 JJ K 5. aerator's Name and Mailing Address Generator's Site Address(if different than mailing address) G eke l- (!,ac-�,r✓rS 0Oo f� f�-�A\ bt,o (,;1�a�� 2� �- �crnC,A cxm C�• °1S� 3 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number e 01'r geC\J 1 5 C X 05 bb�9N 7.Transport' 2 Company Name U.S.EPA a Number L_ &1- �r 't U� t-C Cfz� 8.Designated Facility Name and SiteAdd,eCs$ . U.S.EPA ID Number b- o �� ' Facility's Phone: Vt/ 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 WLNoI. 1. N©N Kc 9-k 00'\-1��u5 k/ - . Sf)V,0 Z 2. Ct�.� Qa.f,� G�� Oy�r��- 1 �M W 3. 4. 14.Special Handling Instructions and Additional Information 5 11- 7/0 - d 0'3k)') 1 �( 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propor'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.It export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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. Generato'Ofls Printed/Typed Name r Signature Month Day Year 16.International ShipmentsImport to U.S. Pod from U.S. Port of entry/exit: ---- F— ❑ ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials WMonth Day Year Transporter 1 Printed/Typed Name SignatureI-- 1 -71 1,3 Zia Transp rte 2 PrintedlTyped Name signature Month Day Year /1 JCA- 18.Discrepancy 18a.Discrepancy Indication Space quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: U.S.EPA ID Number 18b.Alternate Facility(or Generator) J U Facility's Phone: Month Day Year 18c.Signature Tot Facility(or Generator) LUQ z 19.Hazardo s Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1 2. 3. 4. 20. esignated acility Owner or Operator:Codification of receipt of hazardous m rials covered by the manifest except as nded in Item 18a Printed/TypedName Signature Dj� EPA Form 8700-22(Rev. - ous editions are obsol e. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM