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re r <br /> _ . _sg <br /> Pleas. :print or type: (Form designedfor use on elite (12 -pitch) typewriter.) - Form Approved. OMB No, 2050-0039 <br /> Q NIFORM HAZARDOUS 1 G r t r ID Numb q ,n - .y 2 Pa`g f , mer envy R spo se Ph p .- 4 Man set ae 'n b <br /> fIl L Fr 1�:i-v_ 03 oi ,id � � .y Pf r r s%ar a ,, `'�,� � ,, � ? <br /> WASTE MANIFEST a 'P 0 <br /> - 5. Generator Name dM ling Address SKS <br /> N"/, Generators Site Address (if different than bustling address) <br /> t "i LiuSz€. t a'q .ee1 "` t.T .a <br /> Generators Ph $ <br /> 6. T gidp4 1C Aga yN m. P "oor7 U.S. EPA ID Number <br /> No,7. Transporter2Company NU.S. EPA ID Number <br /> Msdy'1# -k1a :1q <br /> B. Designated Facility Name and Site Address 1 ;LME' ?4 04"RUME1 HIS. EPA ID Number <br /> Facility's Phoney <br /> too 9b. U.S. DOT Description (including Proper Shipping Name Hazard Class, ID Number, 10. Containers 11. Total 12, Unit <br /> HM and. aclu'ng Group ( f any)) - - No. Quantity WLNoI. 13. Waste Codes <br /> `� <br /> pa <br /> ez vE 2. <br /> r q—qi Pr z? F Fi VIrl Fee 3. <br /> �k. <br /> if OCT <br /> 4 <br /> e - - <br /> eoial Handling Instructions and Additional Intonation <br /> ce <br /> { E i ! i ! `.'.� !t <br /> jJ t 1 � y <br /> S •di. a4 .tr.Lp r arrk a nt ;: <br /> � CzrJC" 1r o <br /> Pt`s Ci a .1a" Y` 531a - <br /> s � r w. P .. , � : <br /> 15. GENVRATOR'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 classified, park <br /> aged, <br /> and labeJed[placarded, and are in all respects in proper dho for transport according to applicable international and national governmental regulations. If export shipment and l am the Primary <br /> E poder, I testily that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I testily that the waste minlmizat on statement identified in 40 CFR 262.27(a) (if l am a large quantity generator) or.(d) (If l am a small quantity gsnerstor)'[a true. <br /> = Generators/Offerors Printedlryped Name - - Signature/ - Month Day Year <br /> t. t 1 L�'= 40 1. eo` <br /> —� 16. Internalonal Shipments <br /> H ❑ Impart to-6F. ❑'Exportfrom U.S. Pon of entry/exit <br /> z Transporter signature (for exports only): Date leaving U.S.: - - - - ' <br /> w 17. Transporter-Acknowledgment of Receipt of Materials -it Tans der 1 PfindebTypediName Sififflag <br /> O Month Day Year <br /> - <br /> CL t o <br /> Q Transporter2 Pr ntedlTyyName d �„e" SignatureMonth 'Day Year <br /> f� <br /> 18. Discrepancy' .__ r_ ' ..:.� '. <br /> �- 18a. Discrepancy Indication Space ❑ Quantty ❑ Typ e r. Residue ❑ Partial Rejection Full Rejection <br /> ❑ <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) : <br /> U.S. EPA ID Number <br /> ra+. Facility's Phone: <br /> our 18c. Signature ofAlternate FildIlty.(or Generator) - - - <br /> F Month Day Year - <br /> Q <br /> z <br /> ��— ll. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recycling systems) -- <br /> GI )) � fe 'a 2. 3 4.. <br /> Y - In / ? - <br /> 20r Designated Facility Owner or Operator: Certification ofe ptof hazardousm t ials covered by the manifest excepia noted Item lBa 11 , r <br /> bill Pr ted/Typ d Nat f f,,f Signature 'or Month Day Year <br /> r b 4 for <br /> 'Dri ' yt� t _ (�, . <br /> EPA Form 8700-22 (Rev. 3 05) Previous editions are obsolete DE80itNRAT ® F= LMY o® ERATOR <br /> + n_ <br />