Attachment 8 - Manifests.pdf

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Response a77 1 GeneratorlDNumber vÍÍ636øp/%66

UNIFORM HAZARDOUS

WASTE MANIFEST

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UNIFORM HAZARDOUS

WASTE MANIFEST

1. Generator lD Number t¿rn636øæ@,66 Genemto"s Site AddressGeneratois Name

I&TfuæLLæzo

U.S. EPA ID

u.S. EPA lD Numberand Site Address

Name

CTEATI

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SPEnIãLTT WAS:IE SOLT.}TTONS nM/VÀ led Ctr lort trrrlson

Phone:

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'l 0. Containers 1'l - Total

Quanl¡ty

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15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are tully and accurately desøibed above by the pmper shipping name, and are ciassified, packaged, and national govemmental regulalions. lfexport shìpment and I am the Ptimaryand are in all respects in proper condition for hansport according to appl¡cable internat¡onalmarked and labeled/placarded, of this consþnment conform to the terms of the attached EPAAcknowledgment of Consent.Eryorle¡ I certiffthat the contenls statement identifed in 40 CFR 262.27(a) (if I am a large quantity generator) or þ)JjJ I am a small quantity generator) is hue- I certi! thal the waste minimizalion

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É t¡¡ =t¡¡(, Ivr./ U.S, NamePrinted/Typed lLr Port of enlry/exit:

Date U.S.:

shiPments l-l rmporr to u.s.J

1 7. Transporter Ac*nowledgment of Rece¡pt õf Malerials

Signature

18. Disøepancy

Day Year l-l Res¡oue

Manifsl Reference Numbe¡:

Full RejectionnT TypelSa.DiscrepancylndicationSpace n euantity l-l ru*u, *"¡u"oon

U.S. FPA lD Number18b- Altemate Facilìty (or Generator)

Facílivs Pho¡e:

t{rq t

Method Codes (i.e-, codes for hazardous waste Fealment, disposal, and recycling systems)19. Hazardous Waste Report blttt I rltq I

Signature

4.2.

20, Designated Fac¡lity Owner or Operator: Certificatlon of rece¡pt of hazardous malerials covered by tfre manifest except as nded in ltem 18a t f o k =I fr c¡

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1l tl ol z 22.Pasb 23. Manlfost Tracklng Number øÆB'3a559ûDEÍI

21. Generator lD Number vß636æ9Ím,66

UNIFORM HAZARDOUS WASTE MANIFEST

(Continuatlon Sheet)

U.S, EPA

U

24. Generator's Name lqt Ctr-lort [¡rrl¡or

25. Transporter

Company Name

26, Iransfbbr

Company Name

28. Containers 29. Total

Quant¡ty

30. Unit

Wt,/Vol,

31. Waste Codes

No. Tvpe

27a.

HM

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33. Transoorter Acknowledoment of Receiot of Materials

Pr¡nted/Typed Name Signature Month Day Year

34. Transporter Acknowledqment of Receipt of Materials

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35. Discrepancy codes for hazardous waste treatment,36. Hazardous rl t-

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UNIFORM HAZARDOUS

WASTE MANIFEST

of

1 577-877 DAT460 0 3 75

il0 658-1633 BIIÍilIO$ TT 59IC2-5?59 llllrilcs xT 59r2-6759

Address mailing llÀl/BenJartn Ch¡rler $teele [À l?66 laJerrtc tn

Illl/SenJarln Ctarles Steele ÍÀ l166 laJertlc [n

IûTsøpÆ'LLøgz[

Name

T{ASIE SOI¡'TTOilSCT.EAII EâRITI SPECIAT.TT

Bûlllfloîoil EtglloilIBtfü¡, [LC. fÀCilÀ tnxr 17lt [a¡t lle¡a¡der lvenue u.s. Number

62',t-1568n 98t21 253Phone:

10- Containe¡s 9a.

HM

9b. U.S. DOT Description (¡ncludíno and Packing Group (ifany))

Pnoper Shipping Name, Haza¡d Class, ID Numbeç

No.

11. Total

Quantíty

12. Unìt

M./Vol.

13- Waste Codes urt993 Tr$fg u,tiltt[E 1l0ff05, t.0.$. 3 fcII tr' L P oltl 0llt ûnt?g ftsfE (1 LB.l)

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declare he contents thisof åre andandma¡ked aboveaccuratelyand are IN thelabeled/placarded, all in byrôspects prope¡ shipping areandcondilionproper for name, totransport accod¡ng appliæble international and nationalEporte¡ thethal governmental tfcerlify ofcontenls this regulalions. exporl and 8mconsþnment toconform he shipment thetems of the attached Consent.EPAAcknowledgment ofthethatceûry wa6te minimÞation identifisdstatomsnt tn 40 CFR am262.27(al (¡f a large 0r am(b) small(¡f I hus.tsgenerator)

É,o Lk É, u¡ =t¡¡(, lmport to U.S.

Expor{ from U.S. Port ofentry/exit:

Date U.S.:17 of MaterialsRaceipt

18. Disøepancy

Partial Rejeclion Quantity

18a. Discrepancy tndication Space t] It* f] Resioue l-l Frl Ru¡*rion

AJtemate (or u.s. Numbe¡

Phone:

19. Hazardous Waste and

Method Codes codes(i.e., hazardousfor waste lreatrnent, r\ \-r \ t\ 4.

20. Designated Owner orFacility CertificationOperátor: of ofreceipt hazardous materials coveled lhe manifest as ndedexcept in 18aItem hJ() f;

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Form (Rev.12-17) aIe

DESIGNATED FACILITY TO EPA 'S E.MANIFEST SYSTEM

179297-24 ERI Provider: Clean Earth 5557473

P! ease print or type. Form Approved. OMB No. 2050-003E

UNIFORM HAZARDOUS 1 Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number

WASTE MANIFEST MI'7360010303 1 (877) 577-2660 000387169 DAT

5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address)

HAZ/Dr. Joseph Nedicine Crow V HAE/Miles City VA Cons Living 219 S Winchester Ave 219 S Winchester Ave

Generator's Phone:

6. Transpoder 1 Company Name U S. EPA ID Number

CIEAN EARTH SPECIALTY WASTE SOLUI'IONS HNS000110924

7. Transporter 2 Company Name U S EPA ID Number

8. Designated Facility Name and Site Address U S EPA ID Number

HURLINGTON ENVIRONMENTAL, LLC. TACONA PLANT

1791 East Alexander Avenue

Facilit s Phone: TACONA, WA 98421 (253) 627-7568 WADO20257945

9a. 96. 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 Wt Vol.

UN1958 WASTE AEROSOLS 2.1 HQ(DOOl= 199LBS) n881

X DF P

z 2.

UN3248 WASTE MEDICINE, LIQUID, FLAHABLE, TOIIC, N.0.S. POO1 PO46 PO75

X (WARFARIN, COURADIN) 3 (6.1) PGII HQ(POO1= 1OOLBS) DF P P188

NATERIAL NOT REGULATED BY 0.0.T. (WASHINGTON STATE OANGEROUS WTO2

WASTE ONLT, TOIIC) DF P

14. S ecial Handling Instructions and Additional Information

(1) 1788110-91 - ERG(126) PHARMACEUTICAL AEROS (2) 1788195-91 - ERG(131) WASTE PHARMACEUTICAL (3) 1788197-O1 - NON-HCRA

PHARNACEUTI

15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shippmg name, ard are classified, packaged, 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 Primary

Exporter I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent I ce tify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a small quantity generator) is true.

Generator's/Offeror's Printed/Typed Name Signatur Month Day Year

_3 16. International Shipments Import to U S Export from U Port of entry/exit:

Transporter signature (for exports only) Date leaving U.S_:

17 Transporter Acknowledgment of Receipt of Materials

- Transporter 1 Printed/Typed Name Signature 4 Month Da ar z Transporter 2 Pnnted/Typed Name Signature Mo h Day Year

18. Discrepancy

18a. Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection

Manifest Reference Number:

18b. Alternate Facility (or Generator) U S. EPA ID Number

Facility's Phone

18c. Signature of Alternate Facility (or Generator) Month Day Year

Z

19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)

20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a

Printed/Typed Name Signature Month Day Year

IP/ Form 8700-22 (Rev 12 17) Previous editions are obsolete y37

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Number

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Name and

Htl/BenJertn Charle¡ Steele IIIIlll/BcnJuln Ctrarle¡ $teele llÀ

1?66 l¡lêttfc Lr

UNIFORM HAZARDOUS

WASTE MANIFEST

8. Designated Facility Name and Site Address

BtttIXef0X nWfoIIfiîN,, LLC. IICoH P[Hl l?ll Be¡t Àler¡¡ter lvenue

Fac¡l¡tv'sPhone: ?ÀC0H, ff 98121 12531 627'1558

U.S. EPA lD Number

I wnrøzø2llsø¡s f0 Containers

Tvpe

11. Total

Quanl¡ty

12. Unf Wt./tr/ol.

13. Waste Codes No-

9a.

HM

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14- Special Handling Inshuclions andAddilional lnformation

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Exporle¡ I certi! lhat the contents of lhis consþnment conÌorm to the terms of lhe attached EPAAcktowledgmenl of Consent.

small quantity genemtor) is true.I certis that the wasle m¡n¡mizalion statement identified in 40 CFR262.27(a) (if I am a largeluao¡¡+geqeJator) or (b) (ifl am a sr Printedf[yped Name e

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u¡ z, u¡(9

Jt-z, nmporttoU.S. Pod of enlry/exit:

Date leaving U.S.:

Exportfrom U.S-

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17, TransporlerAd<nowledgment of Receipt of Materials

^r Month Day Year

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É, Transporter2 Printef ed Name sigìì*¡Elr Month Day Year

18. Discrepancy l-l Residue

Manifest Reference Number:

l8a. Discrepancy lndicalion Space Full Rejeclion[t*Quantity [-l p.niur Rr¡r"oon u S EPA lD Numberf8b. Altemate Facility (or Generator)

Facìlity's Phone:

Month ljay Year18c. Signature ofAltemale Facility (or Generator)

19. Hazardous Waste Report Management Melhod Codes (i.e., codes for hazardous waste featment, disposal, and recyding systems)

3. 4.1.

20. Designated Facìlity Owner or Operator: Ce¡tifcation of rece¡pt of hazardous mate¡ials covered manifest except as nded in ltem 18a

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of1. Generator lD Number vpa36øf'9ffi6

UNIFORM HAZARDOUS

WASTE MANIFEST

Site Address

I,N/Søpp.LLøg24.

U.S. EPA lD Numbe¡

Name and

U.S.

Number flNn2ø2579115

(ltlI658-1631r0$ Huu$fi Ir 59636-9?ll

Transporler

CI,EAT EERIII SPæIATTT WASIE SOU'ITOTS

Company Name

1?ll last llerander Àvenue ilrnoxrnil[, [[c. llcon PLNI

¡ffi/UÀ ted Ctr lort [errt¡on 368? Ueter¡n¡ Dr roH m$Isfi [T 59636-9?tl

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10 Contã¡neß 12. UnÍt

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No- Tvæ

11. Total

Quantity 9a.

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4.

ï[ Special HanrilinS lnshuclions and Additional lnfomation

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Exporter, I certiff that the contents of th¡s consignmenl conform lo lhe tenns of the attached EPAAclmowledgment of Consent.

I certi! lhat lhe waste minimization statement identified in 40 CFR262.27(Q $lama large quantity generator) or (b) (if I am a small quantity generator) is lrue.

É,o L< É, t¡¡ =t¡¡(, va Generaf or's/Of femf s Printed/Typed tl J È

16. lntemationalShipmenYs n hportto U.S.

Transporter slqnalure (for exports only):

l-l Export fom U.S V Port of entryiexit:

Date leaving U.S.

17. TmnsporterAcknowledgment of Receipt of MaterialsÉ.

t¡¡F É,oÀu, Ê, DaySignature

18. Discrepancy

18a. Discrepancy Indication Space Full RejectionPartial Rejeclion

U.S, EPA lD Number

Quantity Tvæ

Alternate

Phone:

f-l Res¡due

Month Day Year18c. Sþñature ofAltemate Facil$ (or Generator)

19. Hazardous Wasle Report Management Method Codes (i.e., codes lor hazardous waste featment, disposal, and recyding systems)

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20. Designated Facility Owner or Operator: Certification of receþt of hazardous materials covered by ltre manifesl except as nded ¡n lfem 1 8a , tl)Þ t

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A Form 8700-22 (Rev. 12-17) Ptevious DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM

000 DAT

Page

1 877 577

1. Generator lD Number vn36øøLø3ø3

UNIFORM HAZARDOUS

WASTE MANIFEST

ilI/0r. Joseph ïedlclne Crol Y

211 S llnche¡ter lve Generaro/sphone: IITES CIil fT 59311-lTtf

Generatods Site Address

U.S. EPA lD Number

Name

I.'ftspøø.LLø9211clEall ül 558-1633

SFæTåLTT ïâSIE ilI/Itlcs Clty t[ Con [lrlng 2ll S ïlncbe¡ter lve IILE$ CIfl rf 59301-l?5?

TiesigñteãFacmXãmeãnd site Address

BUltlrclox Exllt0mlü,, [[c. rtcilt [ilflr 1?ll Br¡t llerander lvenue

Faclivsphone: TIC0H, tl 98121 (2131 6l?-7568 u.S. EPA lD Number

10. Containers 12. Unit

Wt/Vol- 13- Waste Codes

No. Tvæ

11. Total

Quantity 9a.

HM

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l.¿ above the areardname, dassifed,of thismntenls are and by proper shippingCERTIFICATION: declare $e tully accuratelyhereby consþnment nalional and amI theforcondition to inlernational and export shipment Primaryand tnarc all in according applicable regulalions.govemmentalandmarked respects propeÌ transportlabeled/placarded, theto oflems attachedthècontenlsIhe of this conformconsignmentcerliff thatExporter, am a40tn CFR large quant¡ty(ifminimizationthe waste identifiedstatement a small lrue-t/t

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Namea

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Transporter signalure (for expotts only):

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17. TnansporierAd<nowledgment of Receipt of Materials

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Month Day Year

18. Discrepancy l8a. Discrepancy Indicalion Space Full RejectionPartial Rejection

U.S. EPAID(or Generator)

ResidueTllpeQuantily

Phone:

Management Melhod Codes (i-e., codes for hazardous waste bealment, disposal, and rccyding19, Hazardous Waste

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Exporter, cediry that the conlents ofthis consignment conform 10 lhe tefins of the attached EPAAclcrowledgment that lhe wasle m¡n¡m¡zation statement identified ¡n 40 CFR 26227(a\ (¡f am a Iarge generator) small cl 4 Eì sele tl lmport 10 U.S. Export from U.S. Port of entry/ex¡l:

Oate leaving U.S.:

17. TransporterAcknowledgment of Receipt of Materials Day

IT(3* ( ( t Day

18. Discrepancy

'18a. Discrepancy lndication Space I ouantity Type tr Residue l-l r.*u, *r¡*oon |-l Futt R"¡..tion

Facility (or Number

Phone:

19. Hazardous Waste Report Management Method Codes (i.e-, mdes for hazardous waste featmeot, and rccyding

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EPA Form 17) Previous afe DESIGNATED FACILITY TO EPA's E.MANIFEST SYSTEM

000 31.3 DAT1877l 577 Phone2. Page 1 ot

1. Generalor lD Number t1fl636øø9ffi6

UNIFORM HAZARDOUS

WASTE MANIFEST

(fl¡I558-1533

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U.S- EPA lD Number nilm2ø257945

Facrlity

Bur[ileÍox ilvlmnnilÍ, l,l,c. ftcill Pltxf 1?11 [¡rt Àlerendcr lYenue

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GENERATOR'S/OFFEROR'S CERTIFICATIOI'I: I hereby declare lhat the contents of lhis consignment are tully and marked and labeled/placarded, and are in all respects in propercondilion for lransport according lo applicable inlemalional

Exporte¡ I cerli! that the conlents of this consignment confom 10

I cerii! thal the waste minimizalion stalement identifed in 40 CFR

Sìe tems of lhe attached EPAAcktowledgment of Consent.

262.27(a\ (if I an alarge quanlity generator) or {b) (ifl am a small quanlity generalor) is hue, descdbed above by the proper shipping name, and are dassified, packaged, and national govemmental regulations, lf export shipment and I am $e Primary

Pinted/ïyped Name

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16. lntemational Shipments I hport to U.S.

Tmnsporter sllnalure (for exports only):

rxporttrlnus y'/ Port ofentry/ex¡t

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17. TransporterAcknowledgment of Rece¡pt of Malerials

Year

2Á Day

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É, l¡¡l- É,o ô-an2 É.

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18. Discrepancy

18a- Discrepancy lndication Space Parlial Rejection

U.S- EPA lD Number8b, Altemate Facility (or Generator)

Quantity

Phone:

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Month Day Yeat

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19- Hazardous Waste Repof Management Method Codes (i.e., codes fo¡ hazardous waste teatmenl disposal, and recyding systems)

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20. Designated Facility Owner or Operalor: Cerlification of receipt of hazardous materials mvered by lhe manifest except as nded in ltem 1 8a hJ()i Éf t¡¡ k =I fro q -l

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21. Generator lD Number vÍt63¡6¡m9m6,6

UNIFORM HAZARDOUS WASTE MANIFEST

(Continuation Sheet)

26. Transporter

Company Name U.S,

25. Trânsporter

Company Name

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28. Contâiners 30. Unit

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174255-24 ERI Provider: Clean Earth 5554334

PleEse print or type Form Approved. OMB No. 2050-003E

UNIFORM HAZÁRDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number

WASTE MANIFEST Nf6360090066 1 (877) 577-266 000387175 DAT 5 Generator's Name and Mailing Address Generator's Site Address (if different than mailing address)

HAZ/VA Ned Ctr-Fort Harrison HAZ/VA Med Ctr Fort Harrisons

3687 Veterans Dr 3687 Veterans Dr Generator's Phone: FORT HARRISON NT 59636-9798 (419} 658-1633 Î FORT HARRISON NT 59636-9769

6. Transporter 1 Company Name U S. EPA ID Number

CIEAN EARTH SPECIALTY WASTE SOLITTIONS MNS000110924

7. Transporter 2 Company Name U.S. EPA ID Number

8 Designated Facility Name and Site Address U.S. EPA ID Number

BURLINGTON ENVIRONNENTAL, LLC. TACONA PLANT

1791 East Alexander Avenue Facilit /s Phone: TACONA. WA 98421 (253) 627-7568 WATX)70257945

9a 9b. U S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number 10. Containers 11. Total 12. Unit

HM and Packing Group (if any)) No. Type Quantity Wt Vol

13. Waste Codes

UN2924, VASTE FLAHAHLE LIQUIDS, CORROSIVE, N.0.S., 3(8), PG II , NTO2 DO81 DOO2

z 2 Lij

14. Special Handling Instructions and Additional Information

(1) LPKO33697-88 - DMil INC14-D dl

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15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately desenbed above by the proper shipping name, ard are classified, packaged, marked and tabeled/placarded, and are in all respects in proper condition for transport according to applicable intemational and national govemmental 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) (i m a small quantity generator) is true.

Generator's/Offeror's Printed/Typed Name Signature Month Day Year

16. International Shipments import to U S Export from U.S. Port of entrylexit z Transporter signature (for exports only): Date leaving U.S

17. Transporter Acknowledgment of Receipt of Materials

Tr sporter 1 Printed/Typed Name Si nature Month Day Year

Transporter 2 Printed/Typed Name Signature Month Day Year

18. Discrepancy

18a. Discrepancy indication Space Quantity Type Residue Partial Rejection Full Rejection

Manifest Reference Number:

18b. Attemate Facility (or Generator) U.S. EPA ID Number

Facility's Phone:

18c. Signature of Altemate Facility (or Generator) Month Day Year

Z

19 Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal and recycling systems)

2 3. 4

20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a

Pnnted/Typed Name Signatur Month Day Year

EP/ Form 8700-22 (Rev 12-17) Previous editions are obsolete

183222-24 ERI Provider: Clean Earth 5554334

Plet se print or type. Form Approved OMB No. 2050-003E

UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number

WASTE MANIFEST NT6360090066 2 (877) 577-266f 000 387176 DAT

5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address)

HAZ/VA Ned Ctr-Fort Harrison HAZ/VA Ned Ctr Fort Harrison 3687 Veterans Dr 3687 Veterans Dr

Generator's Phone: FORT HARRISON NT 59636-9790 (419)658-1633 FORT HARRISON NT 59636-9798

6. Transporter 1 Company Name U.S. EPA ID Number

CLEAN EARTH SPECIALTY WASTE SOIHTIONS HNS000110924

7. Transporter 2 Company Name U S. EPA ID Number

8. Designated Facility Name and Site Address U.S. EPA ID Number

BURLINGTON ENVIRONMENTAL, LLC. TACONA PLANT

1791 East Alexander Avenue

Facilit /s Phone: TACOMA, WA 98421 (253) 627-7568 WADO20257945

9a. 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 Wt./Vol.

1 UN3248 VASTE NEDICINE, LIQUID, FLAHABLE, TOXIC, N.0.S. \ 0881 5019 U935 ] (

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X HQ(DOO2= 198 LB) DF P -

14. St ecial Handling Instructions and Additional Information

(1) 1773665-92 - ERG(131) BULK CHHO (N0 SHARP (2) 1844946-O1 - ERG(131) RCRA -

D, U, P FLANNAB )

4EVG8403AG14.4N4EGFI (4) 2488812971-99 - ERG(154) RCHA - CORROSIVE PHA

15. GENERATOR'S/OFFEROR'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 labeled/placarded, and are in all respects in proper condition for transport according to applicable intemational and national govemmental regulations. If export shipment and I am the Pnmary

Exporter, I certify that the contents of this consignment conform to 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 l an small quantity generator) is true.

Gener or's/Offeror's Printed/Typed Name Signa Month Day Year

JU Na lt L1 d 10 | F/

16. Intemational Shipments

Transporter signature (for exports only): Date leaving U.S.:

17. Transporter Acknowledgment of Receipt of Matenals

Transporter 1 Printed/Typed Name Si n e Month Day Year

T ansporter 2 Pnnted/Typed Name ature " Month Day r

18. Discrepancy

18a. Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection

Manifest Reference Number

18b. Altemate Facility (or Generator) U S. EPA ID Number

Facihty's Phone 18c. Signature of Alternate Facility (or Generator) Month Day Year

Z

19. Hazardous Waste Report Management Method Codes (i e., codes for hazardous waste treatment, disposal, and recycling systems)

HM NM HNI

20. Designated Facility Owner or C·perator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a

Printed/Typed Name / Signature Month Day Year aAf2Od M FE I JB#7, , I Lj QL( QL( EP/ . Form 8700-22 (Rev 12 17) Previous editions are obsolete

183222-24 5554334

Please print or type. Form Approved. OMB No. 2050-0039

- - UNIFORM HAZARDOUS WASTE MANIFEST 21. Generator ID Number 22. Page2 23. Manifest Tracking Number

(Continuation Sheet) MT6360090066 of 2 000387176DAT

24. Generator's Name

HAZ/ VA Med Ctr-Fort Harrison 3687 Veterans Dr , FORT HARRISON KT 59636-9700 (4101658-1633

25. Transporter Company Name U.S. EPA ID Number

26. Transporter Company Name U.S. EPA ID Number

27a. 27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 28. Contailers 29. Total 30. Unit

31. Waste Codes

HM and Packing Group (if any)) No. Type Quantity WINol.

5 liM1307 WASTE IYLENES 3 PGIII RQ(1904) 0001 E003 T

RQ DF P

7 KATERIAL NOT REGULATED BY D.0.T. (WASHINGTON STATE DANGEROUS WP01 PHRH

WASTE ONLY, PERSISTENT) DF P

o: 8 NON-RCRA, NON-DOT REGliLATED MATERIAL

Dr j l f P - - -

LU

32. S )ecial Handling Instructions and Additional Information f 5) 1773662-62 - ERG(13% ) SPENT XYIENE WASTE 46.L..2.198th _G¥ QCagir-H· (7) l786109-01 - NON REGULATED IV WAS (B) 1773567-02 - NON-RCRA PHARKACEUTI

33. Transpoder Acknowledgment of Receipt of Materials Printed/Typed Name Signature Month Day Year

34. Transporter Acknowledgment of Receipt of Materials Printed/Typed Name Signature Month Day Year

35. Discrepancy u..

36. Ha rdous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment,disposal, and recycling systems) a

EP/ , Form 8700-22A (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACIUTY TO EPA s e-MANIFEST SYSTEM

UNIFORM HAZARDOUS

WASTE MANIFEST

1. Generator lD Number l'ftÃ?,ÁOútcúrøtÊ,Ê, 000 3 7 92 DAT

2. Page 1 of Emergency Response Phone

5. Generato/s Name and Mailing Address

HÀt/t¡À Xed Ctr-lort tarri¡on 368? lleteran¡ Dr

Generator'sPhone: tnnT HIIITS0I I? qqflß-C?l¡

Gene¡ato/s-Site Address (if difierent than mailing address)

HÀUYÀ lled Ctr fort Harrl¡on 3687 [eteraus I]r mrt H¡nrTsn[ rT {cß16-q7¡et¿tllÍtn-t ß11

U.S. EPA lD Number

8. Designated Faoility Name and Site Address

Bltüil0m[ mfin0xlilril,, [[c. rÀcon PINT 1?01 East Alex¡nder Àvenue

Facitity,sphone:

TÀCilÀ, rÀ 98t21 (2531 627-?568

U.S. EPA lD Number

I wilm2ø257945

10. Containers 12. Unit

MJVol.

13. Waste Codes9a.

HM

9b. U.S. DoT Description (inoluding Proper Shipping Name, Hazard Class, lD Number, and Packing Group (ifany)) No. Type

11. Total

Quantity

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14. Special Handling lnstructions and Additional Information

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Exporter, I certi! that the contents ofthis consìgnment conform to fhe terms of the attached EPAAcknowledgment of Consent.

I cerliñ/ that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (iJþm a small quantity generator) is true.

ú,o L

É.

t¡¡ z, l¡¡(, a0 Jf-lG.Tntemational shipments tr lmport to u.s.

Transporter signafure (for exports only):

l-l Export trom u.s. Port ofentrv/exit:

Date leaving U.S.:

17. TransporterAc*now¡edgment of Receipt of Materials vw

18. Disøepancy

Day l-l Residue

Manifesi Reference Number:

18a. Discrepancy lndication Space Full RejectionQuantity Type l-l Purtiul R"¡urtion

U S EPA ID Number18b. Altemate Facility (or Generator)

Facility's Phone:

1 8c. Signature ofAlternate Facility (or Generator) Month Day Year

19. Hazardous Waste Report Management Method Codes (i-e-, codes for hazardous waste treatrnenl disposal, and recþing systems) ll l¿1t [-+ tqt t+ t¿1f' H t4l

F-

=CJ

Í c¡ t¡l k z,I fr ct hazardous materials covered the manifest as nded in ltem 18a to o 2q

20. Designated Facility Owner or Operator: Certifcation of

AGS"avvnq

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22.Pasb a#a

23. Manifest Tracking Number r1r1ô14? F.O?fìÀ!Tl

21. Generator lD Number rrnc.aÊôttïãût7tíc

UNIFORM HAZARDOUS WASTE MANIFEST

(Continuation Sheet)

26. Transporter

Company Name

25. Transporter

Company Name

24. Generator's Name

HÈUVÀ [ed Ctr-gori flarrl¡on

28. Containers 29. Total

Quantity

30. Unit

Wt./Vol.

31. Waste Codes

No. Type

27b. U.S. DOT Descrìption (incìuding Proper Shipping Name, Hazard Class, ID Numbel and Packing Group (ìf any))HM lrlrll

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32. Special Handling lnstructions and Additional lnformation (51 2¿00t36982-00 - ERC(r311 ÀEI,0SPBÀÏ $T[Il{ llAilT

33. Transporter-Acknowledgment of Receipt of Materials MonthSignature Day YearÉ, tU F É.o o-a¡t z, É.

F waste treatment, disposal,Report Management Method t+ta

Materials34.

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EPA Form 8700-224 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e-MAN¡FEST SYSTEM

000 3 7593 DAT1 877 577

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1. Generator lD Number ttv636øø9ø,ø66

U.S. EPAID Number

Address

LØ924

Transporter wilÍn2ø257945 il0 658-1 633I0[r HÀ[us0ll xf 59636-g?Ce

Designated phone: TÀgoltÀ, IÀ 98t21 (2t3!. 62t-1568

Hll/VÀ Xed Ctr Sort [arrlson 3681 lteteran¡ Dr r0[î HÀ[ms0x rr 59636-97$

HÀI/m led Ctr-lort flarriso¡ 368? Ueteran¡ 0r

Bmtlxef0x HultilrntåI, [[c. trcon ILüt lICl Ea¡t ile¡ander Àvenue

10. Containers

Tvæ

1'1. Total

Quantity

12. Unit

Wt./Vol.

13. Waste Codes

9b- U,S. DOT Descript¡on (including Proper Shipping Name, Hazard Class, lD Number, and Packíng Group (ifany)) No.

9a.

HM

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14. Special Handling lnstruclìons andAdditional lnformation

{11 u13t236TAC-0t - Elct128l LÀ8 [ÀC[$ (21 1P13t236?ÀC-tC - BIC{128) tå8 [Àfis (31 tP13{236TÀC-m - EIC(1531 nB FÀC[s

({l [P13t235TrC-Ct - EIG(171] LÀß nc[s consignment are fully and accurately desøibed above by the proper shippìng name, and are classified, packaged, Exporter, I certiff lhat the contents of {his consignment conform to the terms of the attached EPAAcknowledgment of Consent.

I certi! that the wasle minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a small quantity genemtor) is true.

15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare lhat the contents of th¡s

É,o k É.

t¡¡ z, t¡¡(, l- Generator's/Offerofs Name

Jt-z,

16. lnfemationalshipmànts n Tmnsporter siqnafure lfor exports onlv):

n Port ofentru/exit:

Date leaving U.S.:

Import to U.S. Exportfrom U.S-

17- TmnsporterAcknowledgment of Receipt of Materials

Signature t'î/

Day

18.

18a. Discrepancy lndicalion Space Partial Rejection Full Rejection

Altemate Facility (or

Residue lQuantity Type

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