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Form Approved. OMB No. 2
<br />FIGGIO0
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<br />1..ol ull VI ti F.,
<br />UNIFORM HAZARDOUS
<br />WASTE MANIFEST
<br />1. Generator ID Number
<br />,'_', ,k(,..0C .., 'L-0315-6
<br />2. Page 1 of
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<br />3. Emergency Response Phone
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<br />4. Manifest Tracking Number
<br />0 2 1 3 60 JJ
<br />Generator's Name and Maili g AddressF gAti..%,3,2„) •54-my Atyip_,cct Generator's Site Address (if different than mailing address)
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<br />Generator's Phone:
<br />Transporter 1 Company Name U.S. EPA ID Number
<br />''.. 1 "L--1-''''(''' -1---'6-U..S. EPA Transporter 2 Company Name ID Number
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<br />Designated Facility Name and Site Address Here, k_„oe. _ (y..1 5-i coC k 6.,,, LL 4 U.S. EPA ID Number
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<br />rs,-).10 606e, 1.4.0e,
<br />CA c03 (!)-1
<br />Facility's Phone: 1 ; i c - 57o
<br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit um and Packing Group (if any)) No. Type Quantity WtJVol. 13. VVaste Codes GENERATOR - - 2c.12.04 I-1c, ,,, .._iou5 \Aic ,="4-e, , ,‘, I, c --r,,,,,, ‘. -
<br />(.,Atrben i- c„ 6
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<br />. , . - CV.A OCA2.0r130U WC‘SirC 1-4'11 6 .
<br />\rjakte o i 1-0 -Pre Se))
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<br />14. Special Handling Instructions and Additional Information
<br />ill 822-52
<br />-, 2 ) 1 11 2 7_ -_S / --- 677 -51')f I I - ? 2: - c.-:.r.)(,.. ,
<br />15. GENERATOR'S/OFFERORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, pucka!
<br />marked and labeled/placarded, 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 Primal
<br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent.
<br />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.
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<br />Generator's/Offeroes Printed/Typed Name Signature Month Day
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<br />16. International Shipments
<br />Import to U.S. Export from U.S. Port of entry/exit:
<br />M Transporter signature (for exports only): Date leaving U.S.:
<br />Ce Lu 17. TransporterAcknowledgment of Receipt of Materials 1TRANSPORT Transporter 1 Printed/Typed Name Signature Month Day .- „...
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<br />Transporter 2 Printed/Typed Name Signature Month Day
<br />I I I / FACILITY --o- 18. Discrepancy
<br />Discrepancy Indication Space Quantity Type LII Residue Partial Rejection Full Rejec
<br />Manifest Reference Number:
<br />Alternate Facility (or Generator) U.S. EPA ID Number
<br />Facility's Phone: . I -4--- DESIGNATEE Signature of Alternate Facility (or Generator) Month Day
<br />I
<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycfing systems)
<br />1. 2. 3. 4.
<br />20. Designatea Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a
<br />Printed/Typed Name Signature_ / • Month Day
<br />----77/ /c/ 1 -177-4?, Y ,L , -11 C 1
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<br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENE1
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