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Forrn Approved. OMB No. 2050-0039 Please print or type. . . . GENERAT.OR ) I . . . , UNIFORM HAZARDOUS
<br />WASTE MANIFEST
<br />1. Generator ID Number
<br />-4c 01:,-1 -'5C) el i
<br />2. Page lot
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<br />3. Emergency Response Phone
<br />8co 6W 9672
<br />4. Manifest Tracking Number
<br />Q0645664? GBF
<br />Generator's Name and Mailing Address Generalots Site Address (If different than marling address)
<br />E;t0L032.06A5S F:0 . aux, '2--2-• LDASS0 Akt5-nki 02
<br />G-# i Li tn Tao,
<br />UJiLvaiNic,rnit o i4 £15i11 (.5s136-2,..4 tit 1 41 ST6C i' a CIA) C'P'- 9 6 7-1 S
<br />Generator's Phone:
<br />Transporter 1 Company Name U.S. EPA ID Number
<br />t4R-C 46tARD *3- raWiriCa-• CfP-)4) I- ef:7,S i 1,,Jc.. I CA-e. 0 ec 0°3 I L 4
<br />Transporter 2 Company Name U.S. EPA ID Number
<br />- Ame-cacsA‘\J INVV17--T'et- '-E.Q.k) 'CE-S. i I\J-- I CAROOC)typ3M F)
<br />Designatedlacility Name and Site Mdress U.S. EPA ID Number
<br />US e-CoLoc.1 Ne.sylvicl
<br />...,1-1101/wAki cit--, iiiipc stu,rw-ctmva--0-1
<br />to.accriN i L iu eqe05
<br />Facility's Phone: , etso 2.59 -S9543 I 1-X-41.-30c)i eco.c.
<br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes
<br />HM and Packing Group (deny)) No. Type Quantity Wt./Vol.
<br />I. L•143 119 I
<br />gi Nil
<br />M(Pocewerrs,0400,Ss
<br />) 2 t 22_ z 14b.s._ce-pi 1401-2,44epok.vs COP,SM So LA D
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<br />CttS ubt1-44 -reat , sr.Dp ,,mi 141Ft..4.14Lanz3 -- boo *77'
<br />3. t.lokt -2 024 Liix-atecxxs ki)41.5r& ,i.-1 D , fli..
<br />&fN2-IS k)Iferic& S.pivi 144Pocii-coum-) k t) n-t -0z) ?
<br />' '-1414 (DAV& Sot-I 0 r Poo " C- -rb- ( irnprti re IV "1-v-
<br />.14. Special Handling Instructions and Additional Information
<br />'-4. 1 \ ) P:CD. #1 9- ) \ 3- L1 l_ -:- 12_01 :21
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<br />. -2.83co- i (0 4 1(.0
<br />16. GENERATOR'S/OFFEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and
<br />... marked and labelediplac,arded, and are in all respects in proper condition for transport according to applicable I
<br />..• Exporter, I cattily that the contents of this consignment conform to the terms of the attached EPAAcknowledg
<br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity general
<br />accurately described above by the proper shipping name, and are classified, packaged,
<br />atonal and national governmental regulations. If export shipment and I am the Primary
<br />Consent.
<br />) (if I am a smal .an generator) is
<br />GaheratorslOfferor's PrinteicliTglame At , mr.tr.-wiL Signa Month Day Year
<br />:\DOOPITW LI 1 12- ib 1 PI
<br />e
<br />g
<br />International hipments Import to U.S. Export from U.S, Portal entry/exit
<br />Transporter signature (for exports only): Date leaving U.S.:
<br />illg Transporter Acimowledgment of Receipt of Materials . TRANSPORT! Transporter 1 Printed/Typed,Z , Signe 4 Month Day Year
<br />...„1 tIcKAA_. 0‘: kAAA"Cf.-Z, --.1---Co,--- e7A----V IL2-101 i2 )
<br />Oilliurre Li Month 'Day Year Transporter 2 Printed/Typed Name •: .
<br />M.1441s) kA-v_vt-2x) ,,,,m-r_:-../ ,--c) •1/2 DESIGNATED FACILITY 18. Discrepancy
<br />Discrepancy Indication Space Quantity Type El]Residue Partial Rejection LII Full Rejection
<br />Manifest Reference Number
<br />Alternate Facility (or Generator) U.S. EPA ID Number
<br />Facility's Phone: I
<br />Signature of Alternate Facility (or Generator) Month Day Year
<br />I I
<br />19. Hazardo Wa to ort Management Method Codes (i.e., des ortbig- a rdous waste treatment, dispos and recycling systems)
<br />1. 2. k
<br />71"
<br />3.
<br />\ 111"
<br />4
<br />20. Desi ated Fa lily Owner or Operator. Certification of t of hazardous materials covered by the manife except a in Item 1Ba r_._ .'
<br />Printed/Typed Name - P
<br />/1/\,\VJAMAiv\I
<br />Signature '
<br />\
<br />fix Year
<br /> --- I it DI I 1
<br />bsb ''<DtSIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM EPA Form 8700-22 (Re -17) Previous editions are
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