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-= � HIHIIIHIIIIII�IIIIINH�ilill�l Please pilot or type. 0 0 7 2 7 4 7 6 8 S K S Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number _ 2.P e o 3 �meryepq RgsRo�se PJlopc 4.Manifest Tracking Number WASTE MANIFEST k9-` SKS 5 �71� Generators Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone: c fi TrapsPPrler-1Compapy-Npmel _ U.S.EPA ID Number 7,Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address - T— U.S.EPA ID Number Facility's Phone: - - - ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM nd Packing Group(if any)) 13.Waste Codes No. Type Quantity VVI a- - r, sa z w 3. 4. 14.Special Handling Instructions and Additional Information cn_^r - - 1, in 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and Iatmedrpiacarded,and are in all respects in proper condition for transport according to applicable intematlonal and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 261(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. yh n Generatofs/Ogerome fs Pdnted/Typed NaSignature Mo Y�� M 16.International Shipments ❑Import to U.S. ❑Export Som U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: Cr 17.Transporter Acknowledgment of Receipt of Materials LL TrapspIIkter 1 Printed/T Name �7 Signatu Month Yea, IL QTrans 2 Prin R etl Name Signature Month Day Year F } 18. is panty 1Ba.Discrepancy Indication Space ❑ Quantity ❑Type El Residue El Partial Rejection El Full Rejection r Manifest Reference Number: r 18b.Alternate Facility(or Generator) U.S.EPA ID Number J i V Facility's Phone' W 181 Signature of Alternate Facility(or Generator) Month Da Year Q y z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding systems) D 1 2. 3. 4. e 20.Designated Facility Owne or Operator:Certification of receipt of haundous matenals vered by the manifest ex as n in I IV PnntedrTyped e Signa M DYear EPA Form 8700-22 Rev.12-17) Previous editio sole DES ATE CILITY TO EPA's e-MANIFEST SYSTEM a_