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Please print octvpe. (Form designed for use an elite (12 -pitch) typewriter.). <br />farm Approved. OMB No, 20500035 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete, DESIGNATED <br />UNIFORM HAZARDOUS <br />1, Generator ID Number <br />2 Page 1 of <br />3. Emergency Response Phone <br />4, Manifest TractfJ�lg a pir <br />b <br />WASTE MANIFEST <br />GA!i-010f,�'1't�'i � <br />6 <br />$ "d -7854 <br />1i I cif <br />f , FLE <br />5. Generator's Name and Maiiing Address <br />Generator's Site Adaress (if different than <br />mailing addross) <br />f�%'Ti� l Ltd iscTSc <br />A V ltiC�kt}i'd <br />Generator's PhonoMw. lk r9 <br />6. Transporter 1 Company Name <br />U.S EPA ID Number <br />_ t F <br />�tid$'i`. nri�'i 11—mre`fluisl hr-5.�iY'ixid Imr. . (,qLV) <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />8. Designated Facility Name and Site Address <br />U.S. EPA ID Number <br />Ackrun UuWual <br />6133 Edth Blvd NE <br />Awlw3Y( 87107 p <br />h m NM V 7 1 07 <br />Facililys Phone: 505m' `U"220 <br />ga. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10, Containers <br />11, Total <br />12. Unit <br />HM <br />and Packing Group (if any)) <br />Quantity <br />W1NoI. <br />13, Waste Cedes <br />No. <br />Type <br />gg�� l <br />t'�t17,$.5'dcou.'c'l atme, vS(1'If 1 r 00y S4.3�E-i s) <br />r" <br />�iJ <br />F�' <br />♦'ii'. I <br />I1%Wt`�'s'#�-'i{'iC�t.A <br />._... <br />2 <br />w <br />I <br />f <br />3. <br />I <br />4 <br />) <br />I <br />14. Special Handling Instructions and Additional Information <br />pr*tct mvi x o7vi m5rAgt t 4: WW? <br />MIAMI ACTH PaA u i �,!c) r� <br />r <br />.D L..l vl <br />Al. �G� <br />15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above <br />by the proper shipping name, <br />and are classified, packaged, <br />marked and labeled,'placarded, and are in all respects in proper condition for transport <br />according to applicable international and national governmental regulations. It export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknovdedgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (!(I am a <br />large quantity generator) or (b) (if I am a small quantity generpJgl) <br />is true. <br />Generalor's1011erors PnnledtTyped Name <br />51grialuris I ♦ N <br />eMonth ay 705r <br />.-r <br />F- <br />International Shipments <br />Import to U.S. <br />n Export from U.S. Port of entry/exit:.--... <br />_ W....._..,..__..,_ <br />_....__.....__._ ...._._ <br />116. <br />Transporter signature (for exports only); <br />pate leaving U.S.: <br />UM <br />17. TransporlerAcknmvledgment of Receipt of Materials <br />Transporter 1 PmiledlTyped Name <br />Signature <br />Month Day year <br />IL <br />k <br />Z <br />Transporter 2 Pffnled(Typed Name <br />Signature <br />Month Day Year <br />Q <br />h- <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity El Type <br />El Residue1 <br />: � Partial Re'ectlon <br />EJ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) <br />U S. EPA lD Number <br />J <br />U <br />L <br />Facility's Phone; <br />B <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />Q <br />2 <br />4 <br />19. Hazardous Waste Report Management Method Codes (i.e., codas for hazardous waste <br />treatment, disposal, and recyding systems) <br />0 <br />1. { <br />,L <br />2. <br />3. <br />4 <br />11 <br />20. Designated Facility Ovmer or Operator! Cenillcalion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />PrintadlTyped Name r `t r <br />�, � �A 1(� <br />Signature r s <br />Month Dqy, Year <br />1 A I0 <br />rr :- <br />0z <br />FACILITY TO GENERATOR <br />