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<br /> UNIFORM HAZARDOUS 1 Gen torlO Number_ sF 3 2 Pegaofq 3 E rgency R.rcfjg*prise PflpneIF. k M�yntT Ac' gN b r
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<br /> �F 5. 6 nerators Name and Mailing Address ; Generators Site Address (If dlBerent than mailing address)
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<br /> TTrnpoder 2 Company Nam - - 98 } �t4 - U " ' U.S ERI ID Number
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<br /> B. Designated Faclify Name and SiteAddressE C $ p11 M.IFF, IF V t 'pq . . PA ID Number -
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<br /> got - 9b. U.S. DOT Description (including Proper Shipping Name Hazard Class, ID Number, 10. Containers 11. Total 12. Unit
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<br /> and Packing Group (f any)) No. y�` Quantity Wt,Nol.* 13,Waste Codes
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<br /> 15. - GENERATOR'S/OFFERORS CERTIFICATION: 'I berebj declare that the contents of this consignmentate fuiiy and accurately described above by the proper shipping name am are classified, packaged
<br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable ntemafional and national governmental regulations, If export shipment and I am the Primary . . -
<br /> Exporter, l cedi(ythat the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I I '
<br /> I certify that the waste minimization statement incurred in 40 CFR 262.27(a) ( f I am a targe quantity generator) or (b) ( fl am 'a small quantity generator) is true ,:- -
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<br /> 1 16. International Shipments
<br /> i- . 1 ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit
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<br /> Transporter signature (for exporfsdnly): Date leaving U.S.: _
<br /> w 17. Transporter Acknowledgment of Receipt of Materials' - - I r -
<br /> OTransporter1 PnntedTJyp d N - - Sig at � Math Day, Year
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<br /> Trail poder2 Pnnted1TayIS o'Nanno '� - Signature �,.-°"M "�'" Month Day Year
<br /> 1B. Discrepancy
<br /> . � 18a. Discrepancy Indication Space ❑ Quantity - - ❑ Type - -
<br /> ❑ Residue ❑ Partial Rejection ❑ Ful Rejection
<br /> Manifest Rfere ce Number:
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<br /> =.=y. Hazardous Waste Report Management Method Codes fbF, codes for hazardouswaste treatment disposal, and recycling.systems) - I '
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<br /> 20. Designated Facility Owner or Operator: Cargill tion of receipt of hazardous materials covered bythe manifest except dinned ip Iterri 189 - _
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<br /> EPA Farm 8700-22 (Rev, 3-05) Previous edhons are obs�te e
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