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8. Designated Fanlity Name ad Site gtldress
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marked and labeled/placarded and are n all respects in proper contlieon for transport accord according to applicable'nlernaaccu and national ^
Exporter, I certify (hat the contents of This consinntrcontorm to the fetrms of the attached dingEPA to Polka le at otlConsenl. Cg
I certity that the waste mmtm nation statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (h) (if�l am alsmall nuangawe by tl
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17. hansporterAcknowletlgment of Receipt of Materials
18. Discrepancy
- 18a. Discrepancy Indication Space
F 186. Alternate Facility (or Generator
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C3 18c. Signature ofAlternate Facili
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19. Hazardous Waste Report Manage,
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❑ Quantity
❑Export
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Pont of entry/exit:
Dale leavinn U s
❑Type
Method Codes (i.e., codes for hazardous waste treatment, disposal, and
❑Residue
20. Designated Facility Owner or Operator: Certifigtion of receipt o(hazardous mafedals covered by the manifest except as nded in Item 18a
Prinfedllyped Name
EPA Fou 8700,22Rev. 12-1 j, Previot
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❑ Partial Rejection
GENERATOR'S INITIAL COPY
GW 240�47415G-01}1 Ppry