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Please print or type.(Form designed for use on elite{12-pitch}typewriter.) Form Approved.DMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1rGerieratuIia Number. 2.Page 1 of .3.Erstergency.Rgsponse ane, _ 4.MaF&ATra Hum r <br /> WASTEMANIFEST 01 ' 907 JJK <br /> 5.Generators Name and Mailing Add }."s ._ '" t r ra=' Gell'&atotSil'e+Andress(if different than mail-mg address).. <br /> 'o. 1rt�xt !� irt}it <br /> •..1 +� <br /> Generators Phone: _ 144 76"b0VtPjVPhA W&M"na vlo)- '0 f '-d *o*n- <br /> 6. <br /> f7 r tt u9r 1175n ihn 7El iA cm3 s <br /> 6.Transporter 1 Company Name f1.S.EPA'IQ Number <br /> 7.Transpoffer 2 Company Name U.S.EPA 1D Number <br /> 9.Designated FaoAity Name and Site Address U.S.EPA Id Number <br /> K€Pm AWMA u. <br /> Cit1'Yvon C W222-2799SA. <br /> •{inn .:y._ S.uv.i r M;r!'(..Y :�I�x!!T '..g;'...' .y..����$:-�!�ity[ <br /> Fadli s Phone:' . r �. na vi. <br /> ga 9b.11.5.DOT Desc pion(ihduding Proper Shipping Name,Hazard Gass 10,Nurnbe, 16.Containers 11.Total 12.Unit q3.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Ruantity Wt.Nal. <br /> � .:...:�2mrkr:.-�c3"'�'.;,...:.:.w-:z:•^::,r :YGc:: ';•.'. 79tTdti7:�..._i .� ....;. - .:� .�+.:;g•G b.r•. <br /> � '_S1.(it�i�.,1Af �1.J� i'�•fti3.7f: - ;n �.': <br /> n 11 ERG*12aa. : <br /> z 2. <br /> LU <br /> C9 <br /> 3. <br /> 4. <br /> 14.Special Handling Inch cWrffditional Information <br /> 15. GENERATOWSIQFFEROR'S CERTIFICATION: I hereby declare that the contents of thls consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and iabaledlplacarded,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,l certify that the contents of this consignment conform to fine terms of the attached EPA Acknowledgment of Consent <br /> 1 certify that the waste minimlzatlon statement identified In 4&OFR 262,27(a)(if I em a large quantity generator)or(b)(V I am a small quantity generator}is tree. <br /> Generator009aroes PrintedfTyped Name Signature Month Day Year <br /> F 16.Intemat oral Shipments ❑Impart to U.S. ❑Expert from U.S. Port of entrylemdt <br /> a Transporter signature(for experts only): Date leaving U'S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed(7yped Name Signature # + Month Day Year <br /> Ix <br /> Transporter 2 PrintedfTyped Name Signature "~� Month Day Year <br /> cc <br /> � P <br /> H <br /> 18-Olscrepancy <br /> 18L Discrepancy lndic9on Space ❑aM1 � El <br /> 4uResidue Partial Rejection Full Rejection <br /> Manifest Reference Number. <br /> 186.Alternate Facility(or Generatof) U.S.EPA ID Number <br /> a <br /> U <br /> LL Facility`s Phone: <br /> Lu 18c.Slgnature of Altemate Facility or Generator) Month Day Ycar <br /> Q <br /> 2 <br /> f a 9.Hazardous Waste Report Management Mettrod Codes(€.a.,codes for hazardous waste treatment,dlsposal,and recycling systems) <br /> r� 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of mmipt of hazardous rnaterfals covered by the manifest exogas noted in Item 1.8a. <br /> Print�CWN�j r e- 5lgnature ,• �`f j �. Month. Day Year <br /> f rf p <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. TRANSPORTER'S COPY <br />