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Please print or type. Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS I-GenoratorlDNumbar 2,Page 1 of 3.Emergency Response Phone 4.Manhst7rac"Number <br /> ALOC <br /> WASTE MANIFEST '­ -W, I -303M 1 8 A 1-4 2-4-Wi I X) 2 2 6 15 JJK <br /> J_ 5.GeneratoE s Name and Mailing Addw G8n0rat&s Ve A ddress(ff diftent than mailing address} <br /> K1*XVft' t N 3/,Kw ij6k4 <br /> I <br /> Generators Phone: <br /> 6,Transporter 1 Company Name U.S.EPA ID Number <br /> 7-Transporter 2 Company Name <br /> U.S.EPA 10 Number <br /> 8,Designated FadVity Name and Site Address U.S.EPA ID Number <br /> f mr-1 CQrf"CX1 GA kXi2_?2-2ebV U,'�/-% <br /> FaciCly's Phone-, <br /> ga. 9b.U.S.DOT Description.(incMing Proper Shipping Name,Hazard Class,ID Number, 10,Containers <br /> HM and Packing Group.fit any)) 11.Total 12.Unit 13.Waste Codes <br /> No. Type Qu­tftY W61ki, <br /> t. <br /> -4 W <br /> 2. <br /> LU <br /> L7 i <br /> 3. <br /> L 4' <br /> 'C Special Handling InsWcOms and Additional Information <br /> g-i <br /> A�T i <br /> tl 5_G'E_NER_AT0iR'S/0FFER0FV8 CERTIFICATION: I hereby dedwe that the contents of this consignment are Cully and accurately described above by the proper shipping naMer and are classifiad,packaged, <br /> marked and labelled/placarded,and are in A respects In proper owdition for transport according to applicable international and national govemmental.regulations.V export shipment and I am the Primary <br /> Exporter,I certify that the contents of the consignment oonfirm to ft terms of the attached F-PA Acknowledgment of CmsenL <br /> 1:certify that the waste minimization statement identified in 40 CPR 262.27(a)(it I am a large quantity 9"ratix)or(b)(If I am a small quantify generator)15 IrM <br /> G*wratorwufferoj,s PriatediTyped Now Signature Month Day Year <br /> I F <br /> _j 15.Intamahma[Shipments <br /> L]Import to U.S. ❑&Pon k.Uz. Pon of entryleml: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17,Transporter Acknowledgment of Receipt of Materials <br /> Traf45porter I Pfinted(Typed Nam® Signature <br /> Month Day Year <br /> Transporter 2 Prmte&Tped Name Signature I Month Day <br /> Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Ll Quantity 0Typ- El Residue El Panda{Rejection ❑Full Rejection <br /> Manitert Reference Number. <br /> IShAternate Facility(or Generator} U.S.EPA ID Number <br /> :3 <br /> 0 <br /> I Facilty's Phone: <br /> LO 1 Be.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z - 1 1 <br /> U <br /> 'I Hazardous Waste Report Management Method Codes ji.s.,codes for hazardous waste treatment,disposal.and recong systems) <br /> A 4. <br /> 20.Dasfgnalvd Facility Owner or Operator:Ceffikalion of receipt of hmr*u5 materials covered by the manifiast.exce <br /> P"t I red Narr!�., �pt asmded In Item 183 <br /> Sipalt re, � Wnth Day year <br /> EPA Form 8700-22(Rev.12-17) Previous EdlVarts are obsotelei" TRANSPORTER COPY <br />