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I I � Form Approved OMB No.2050-0039 Please print or type. 4. vilest Tracking Number UNIFORM HAZARDOUS Generator ID Number e, / 2.Page 1 0l 3.Emergency Response Phone 23339365 J J K WASTE MANIFEST C�)��031 /2�cD� D—�3��37� Genoralors Silr.Address A di ferentthan maul address) 0 5 Generators Name and Mailing Address !ti/1 CSG TO G� a EFTA MGl1-o�Z F72��G�T 237D LA �i5a1--FO IIUGs',Dr-Qb 's 6PJFcH PhPXLIAY 1.oD�i I } okiNS CR«Y� U/i 3oaS 7 a Generators PhoneU S -PA ID Number G c 6.Transporter 1 Company Name D 512u G 2 3 72 N t,/F"C` T n/ e"T U.° -PA ID Number 7.Transporter 2 Company Name O 0� -q,V U EPA ID Number J m 8 Designated Fadlity,Name and Z, Address r Rosh)// hnrD ova):Z �G 3o LIA7 t cr# So7R13E r 1„ ,G 8--.x9, h ttpo2�yo5O)5 Facility's Phone ^ —Co 72 -1 109a e p 9 Shipping No Containers ,1 tat 12.Unit 13.Waste Codes _b.U.S.DOT Description(including Proper Shi I Name,Hazard Class.to Number, (I ntily Wt.Nol. HM and Packing Group(1f any)) No. Type ,.�,yrJl✓ kcR�9- l}1t ,e�uS l✓ �r�J 0 2 �. W v*BSo FNT V HAMMy7Z cLFAI✓JS T J Wo Y,- RCR-ALU Hg2/�IzDoUs vAs71_� l� 13 �RrNsFAT,� 4� t}�,bMcTZ GLEAN xTJ 3 pF 1 0 � ��, ' Ah�l✓ G/2A NAZhWV0(1S LiASTF, L�Q(/x 135 E Non/ 2 +P UASTfi, 5o LTA �)2 Y Lf i�, T7-07E) P p TBS 2o5J 14.Special Handling Instructions and Additional Informtion a � d � - -,- a1(? o4 u�J ,97TH: E Ak RClf'� �P� tiff Eta/ N�A/a Z 15 GENERATOR'SIOFFEROR'SCERTIFICATION:Thereby declare That the contents of this consignment are fully and accurately described above b r proper shipping name,and are classified,packaged, e marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable International and nafional govemmen gulations.If export shipment and I am the Primary the terms of the attached EPA Acknowledgment 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 gene r)is true. Exporter,I certify that the contents of this consignment conform to Signature Month Day Year .a Generator's/Offerors PrintedlTyped Name l�,,� �' m O/v 86th LF 0 S,�ZA MoTeR rR� Y7- XOP hii Y J 16.Intemabonal Shipments ❑Import to U.S Export from U.S. Port of entry/eM: f- Date leaving U S.: az Transporter signature(for exports only): 8 io� 17.TransporterAcknowfedgment of Receipt of Materials Ofal 1 Printed ed Name Signature Monty Day Year a Signature Monty Day Year • Q Transporter 2 Printed Typed Name t- 18.Discrepancy • 18a Discrepancy Indication Space Quantity ❑Type ❑Residue Partial Rejection ❑Full Rejection Manifest Reference Number: 18b Allemate Facility(or Generator) U.S.EPA ID Number J - U Facility's Phone: LI e Facility(or Generator) Month Day Yea 18c.Signature of Altemat 1 r C9 19.Hazardous Waste Report Management Method Codes It e,codes for hazardous waste treatment,disposal,and recycling systems) U) 4 ltl 1 2 3. :�J M� � N N of 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded in Item a N P nted/Typed Name Signature Month Day Year 0 N EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATE FACILITY TO EPA's e•MANIFEST SYSTEM