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bK bH L P# c 0 0 8 3 4 2 8 3 7 S K S Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Track Number WASTE MANIFEST COLk+t[11t�`7c)7, 1 1— �i—'#�+�—I �tO 1008312837 SKS 5.Generator's Name and Mailing Address Generalors Site Address(if different than mailing address) k t L;;"iercill Ln 61j-L-l 1-01;1 GO `j;);'40-0000 Generator's Phone- 6. hone 6.Transporter 1 Company Name U.S.EPA ID Number Vik! cVY—f';1- tN SY51EMS iNIL iXIi+al1�� 7,Tr sporter 2 Company Name U.S.EPA ID Number (1 4C— C r . fes p 3 93 2d 8.Designated Facility Name and Site AddressL1L-t HN HW6UHb IGtiF1��Y MULIN j H i U.S.EPA ID Number J Mill LHS I', i ]i LAS N;l KN6LLS E 1,i 1 41, Ill 1` 1--till KNIl U) 64066 4s�1-ti1�4-ti�:l� IUfL?`�Si,ltlll �4� Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13-Waste Codes HM and Packing Group(if any)) No Type Quantity wtlVol. 1Niiifil NUN-HiLhil I I-iHLi-lROULIS WAST t., bUL10, a Aw��r�E HND OIL), �� w Z 2 w 3 4- 14,Special Handling Instructions and Additional Information IU:ufYiIUM. +4c_ -rh1 I*t �itak#UivY# e91c1-41�ti-IlStil-�ri�SFCillFi-Lontract retained IUy generator canters agency arji.tiarit. 15. GENERATOR'S10FFEROR'S C RTIFICATION: 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 labeiedlplacarded,and are in all respects in proper condition for transport according to applicable international 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 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true, Generator'slOfferor's PrintedlTyped Name Signa Month Day Year 16.International Shipments H ❑Import to U.S. ❑Export from U. Poe i entrylexi M Transporter signature(for exports only): teaving U.S.: W 17.TransparlerAcknowledgmenl of Receipt of Materials T p er 1 Printedlfyp are Signat Month Day Year A / e 3 Z T nspo5er 2 Frintedrryped N me 5ignal,r" Month Day Year F- 18.Discrepancy 18a-Discrepancy Indication Space ❑ Ouant T Residue ty ❑Type El ❑Partial Rejection ❑Full Rejection Manifest Reference Number. F 18b.Alternate Facility(or Generator) U.S.EPA ID Number V LL Faciiitys Phone: C3 18c,Signature of Alternate Facility(or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Method Codes ii e.,codes for hazardous waste treatment.disposal,and recycling systems) G 1. 2. --F . 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prime d am Si ature M nth a Year y � 2z EPA Form 8700-22(Rev.12.17) Previous editions are obsolete ESIGNATEA FACILITY TO A's e-MANIFEST SYSTEM