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Form Approved.OMB No.2050-0039 <br /> Please print or type.(Form designed for use on elite 112-pitch)typewriter.) 4.TaistTrackin Number <br /> UNIFORM HAZARDOUS 1•Generator ID Num r2.Page 1 of 3.Emergency Response Phone9WASTE MANIFEST AJ"3' 927 . J J K <br /> 5.Generator's Name and Mailing Addrese Generator s Site Address(if different than mailing address) <br /> A) <br /> NE C=S17. <br /> : f_re DORADO--0 <br /> r <br /> Generator's Phone:, -;.7'7J':d?G U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> .iai2 ci!'- F::Uiafc�EfLTf+.! _ER:�-'tCES H.-I'C', <br /> R.= <br /> 7.Trans e 2 Company Name U.S.EPA ID Number� �- <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> p.4 Fi_RE'4CCE P.E:r.1„tE=; 4x32~2:_ <br /> 1;15EA"r FICO 15161.s$D. <br /> F.r,1GEi_E3,C^. K23 <br /> Facility's Phone: <br /> 9b.U.S.DOT Description(including Proper ipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 9a' No. Type Quantity Wt.Nol. <br /> HM and Packing Group(if any)) <br /> 1. l r.ile.G3, taASTE GZA.SOiJNE .3,'r°i' _ Ji '� 1- <br /> 5 <br /> Z 2. <br /> UJ <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional InfoTriation <br /> 931 jPPCFIi..E.#F t -- <br /> E.R. C01 RACTOR: P.:4ACrS E, ARONMEFri AL <br /> HANDLERS. SHD'JLD BE TRAIN D 1440 USE .APZ:'R0'V=_D PPE <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATIO : I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this cons gnment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement dentified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneratoeslOfferor's Printed/Typed Name Signature Month Day Year <br /> 1 <br /> J 16.International Shipments ❑Export from U.S. Port of entry/exit: <br /> F ❑Import t U.S. <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Meter als <br /> Transporterl PrintedlTypedName Signature Month Day Year <br /> CL <br /> ZQ Transpo f�ratedlTyped Name j ' Signat03 ,ure Mon ear <br /> 18.Discrepancy <br /> i <br /> 18a.Discrepancy Indication SpaceV El Full Rejection <br /> ❑ Qua tity ❑Type El Residue ❑Partial Rejection 1 <br /> Manifest Reference Number: <br /> i8b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> 3 <br /> L FacilitysPhone: Month Day Year <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Meth& Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 3. 4. <br /> . / 7 / 2. <br /> 20.Designated Facility Owner or Operator:Certific3tion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedr yped Name Signature - %'.r .-- . Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATQF <br />