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RECEIVED VIA EMAIL ON 09/02/2022 <br /> Plea,se pi int or type, Fonn Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genera®r IU Number Z,gage 1 of 3.Emergency Rasome Phone '114--MTnifest Tracking Number <br /> WASTE MANIFEST 74 022830388 JJK <br /> and Mailing Address Qrnerat or's Site Address(if different than roal!ing adamss) <br /> Gonarato?sphonL7 Q� <br /> 6.Transporter 1 qx6pwy Name <br /> U.S.EPA 11)Number <br /> 7.Transporter-2 Coll)any arrip U.S.EPA fl)Number <br /> O.Oes Wed P, alt, Name SkeAddress <br /> US,EPA ID Numbel- <br /> Facitty'riPhone: <br /> 9,j, 9b.U,S.DOT Description;including Proper Shipping Name,Hazard Ciass,ID Number, .110.Containers <br /> P 11.Total 12,Unit <br /> Htj end Packing Group(if arl)) No. Type Quallf,ty 4'4121. <br /> 13.'Arasle Codes <br /> ? J <br /> 0 pc C <br /> 00 t b X( j/c <br /> T7— x <br /> W <br /> O-Of <br /> ........... <br /> 4. <br /> 14.ji94F4andlinq Insiruclionz <br /> A� <br /> 15. GENERokTOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the conterb of this consignment are fully and accurately desabod above by the proper shipping narne"T"J are c7la—s.fadpackaqed, <br /> marked and labeflediplar arded,and are in 3;1 rospecm in proper wirditton for transport according to appl;(ab'.e international and national governmental regulations,If export sIiipjnbmt and I am the Primary <br /> Exporter, <br /> -I certify that the contents of thl�wn5ignment conform to ilia terms of the attached ElAftnowledginprit of Consent. <br /> I ceriFy lhai:he waste minimization statement identified in 40 CFR 262.277(a)(f I an,a large quarifity generator)or (fl ams small quantity genara[V)is Ij ue, <br /> Goner s,"Offer;r's PrintecUTyped Name Signature —WIG—flDay Year <br /> j <br /> Atoll 1) P <br /> 16,Intemational Shipments <br /> Inipoil to U.S. F]Export from U.S. Port of antryiexit: <br /> Transporter signature(for exports only): xr Data leaving U.S.: <br /> 17.Transporter Acknowledgment of Recolpt of h4w.ehals <br /> LU <br /> Transporter 1 Printed/Ty a e Signature Month Day Year <br /> 17 119r[ e-J <br /> Zr1lIsporter 2 P.intod!rypt'IqarTje Sigfmiure Month Day Year <br /> I X <br /> 18.Discrepancy <br /> SSS 18a,Disrrepairicy Inuicalian Sp". Quar,tity OTYPF 1.1 Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> I Bb.A;ternate Facility(or Generator) U,S.EPA ID I"Irnber <br /> Facility's Phone: <br /> lk Signature ofMemare Facility(or Genera , <br /> Month Day Year <br /> Kt <br /> ;Z <br /> 0 '19.Hazardous <br /> �Fj — ou Waste Report Management Codes(!,a., WaFletreatment.disposal,and recycling systems) <br /> --- <br /> 2. T <br /> .............. <br /> 20.Designated Facility awiet or Operator:Cerliflicaijon ofreceipt othazardous materials coymd by the manifest except asnoted in Item 1 a <br /> FnataOtI yped Name <br /> Signature Man[. a, Yea <br /> -r <br /> EPA Fenn 8700.22(Rev,IT-1 7) Previous editions are obsolete. X — DESIGNATED FACILITY TO EPA's �-M.ANWEST'SYST7,� <br />