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Please Writ or type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZ%RDOUS 11.Generator[D Number 2.page i of 3,Emergency Response Phone4.Manftt Tracking Number <br /> WASTE MANIFEST n n <br /> 5.Generator's Name and Mai—ling Address =F`2026406 JJK_ <br /> .3 Generator's Site Address Of different then-mailing address) <br /> �1_4r�Tyf I --i-r�1-: 'T 4 <br /> Generator's Phone: 4A. <br /> 6.Transporter 1 Compaq Naive- US-EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> 9,Cognatad Fadllty Name and Site Address US.EPA ID Number <br /> �*Akml North Aomda 86 <br /> M <br /> m, <br /> FaPhone: Aro <br /> ga. 9b.U.S.DOT Description{including ProW Shipping Nam,Hazard Class,ID Number, 10 Confa vers 11_Total12.Unit <br /> Him and Packing Group(If any)) No. 7Ty P7 ouantity X/Vot. 13.Waste Codes <br /> 1. <br /> 1W-1'40= "n".-.tri <br /> 0 <br /> 4. 1 <br /> `4,Special Handling Instructions and Additional Information <br /> 15. GENERATOR'SIOFFEROR'S CERT1 are <br /> I hereby declare that the contents of this consignment are fully and accurately described above by U�a proper shipping name,and are classified,packaged, <br /> in aftd and labeled1placarded,and we Wall respects in proper condition for transport according to applicable international and nallonal governmental regu[sVons,ff export shipment and I am the primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acirrmledgmensi of Consent. <br /> I certify that the waste.minimization-statement identified in 40 CFR 26217(a)(9 1 am a large quantity generator)or(b)(KI am a small quardity,generator)is true- <br /> GeneratoeslOfferofs PrinlediTyped Name Sigrrature Month Day year <br /> ❑lmpmtt,U'S, EPd from U <br /> .S. Part of en Fexit <br /> Transporter signature(for exports orml Date leaving U.S.: <br /> 17.Transporter Adwwledgment of Receipt of Materials <br /> Transporter I PrintedlTyped Name r i Signature Month Day Year <br /> Q. <br /> ax <br /> Transporter 2 Pdnk47yped Name Signature fol OT Day Year <br /> 78.Qlscrepeacy <br /> 180.Discrepancy Indication Space ❑ Quantity Type EIResidue ❑Ptl Rjacbm, ❑Full rejection <br /> Manifest Reference Number.I 86.Alternate Facility(or Genesatw) U.S.EPA ID Number <br /> :3 <br /> L) <br /> LL Facility's phorls: <br /> 0 1 <br /> LLI 18c.Signature of Altemate Fadlq(or Generator] Month Day Year <br /> Hazardous Waste Report Man;Veftmllt Method Codes V.&,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. <br /> z6-l,esig.atd Facility_biOwnerOOperator Certification of receipt of hazardous materials covered by the marrf4st eXOePt as noted in Item 18a <br /> PrintedyPed Name Signature <br /> 1 Month Day Year <br /> ell <br /> EPA Form 8700-22(Rev.1247) Previous editions are obsolete. TRANSPORT CR COPY <br />