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Please prkt(or type. Forth Aopmvd.OMB No.2050-0639 <br /> UNIFORM HAZARDOUS ,.Generator l0 Number 2 Page 1 of 3.lEnergency Resporm Ra* 4.Maniffest01228'3756 F L E <br /> WASTE MANIFEST <br /> s Generelafe Name and Me9'rg Address Generators S8e Mildness(a dt mmt man maang adaess> <br /> S <br /> uer Stogies Industry <br /> 6t'aara llo)r's , _A IVICKk Atin <br /> e Traroporter 1 Compary Name US.EPA H)Number <br /> Advanced Chemical Transport lncJDBA ACTEWRU CAR000070540 <br /> 7.Trarnporier 2 Canary Name US.EPA b Number <br /> Woddvode Recovery System, Inc CAR000175422 <br /> 8.Deaignaled Facbly Name end SAs Address U.S.EPA 10 Number <br /> Y urs YES, LLC AZR000515824 <br /> 2730 E. 13th St <br /> Ywtta' AZ 85385 <br /> F VoPhone: 928-344-8628 <br /> 9a. 9b.U.S.DOT Desoom CkkWlrg Proper Shipping Name,Hazard Close,ID Number, 10.Contaira s it.Tolal 12 Unit 13,Waste Codes <br /> HM 8W PWW9 GODnP(asry)) No. Type Quermy WUVOL <br /> I-Non-RCRA Hazardous Waste Liquid(Urea Liquor,Waler) <br /> � L•�i DM <br /> t� � p 133 <br /> 2Non•RCRA Hazardous Waste Solid(Absorbent,Urea � P35 <br /> Liquor) 1 <br /> 3. <br /> 4. <br /> 14. llarX% Pr4eQ NXrbW 185IM DMZTIGI-d#. CM4670 <br /> 1) 1812308 SUY- C. I. (-LD%A <br /> 2) 1812307 SL Y--- ----, 1. i Y, <br /> 15. GENERATDR'stoFFEROR'8 CERTIFICATION:I hereby dedare Thal the mdm d tth ewaoT nerd grg trey and=wA y desftW above by ttre paper sl>+ppirg nama,and are dessified,packaged, <br /> marked and iabsied sanded,and are kr aB respects In proper oond1h for lrarrsM aoom*V b aWk:abte kftmaftaland rational rvemmantal regulak-If export sIdpriss and I am Iho Primary <br /> Exporter.I cw*that ore conlertts of this co*"rient comlorm loft terms of Yrs attacW EPAAckjvw Ir"of Cement. <br /> I caMy that trre waste mirdminibm statement idenlifled in 40 CFR 262.Z7(a)V I am a large r w'*Y generaw or(b)(UI eat a small WMTMy gemeratorl Is true <br /> Generatorsnffemes PrtnbdfTyped Name , Month Day Yaw <br /> 16.Inkrtutioral ❑wport to U.S. ❑Export hum US. Pato( � <br /> Trarsperter (for exports ody): <br /> tr 17.Traisporier AdmowledgrreM ol Racelpl of Materials <br /> ransporler 1 PrhWyped Name Signatura Monis Day Year <br /> ranapor,er kae Mloft Day Year <br /> 1a.D>isaepaney <br /> 18a.Discrepancy kdEcallm Space ❑ ❑Type ❑Residue ❑ParW R*di n ❑Full Rsfecl o <br /> Magee p0elarer1ceNum>er. <br /> 18b.Altemals Facility(or Generator) U S.EPA ID Number <br /> v <br /> Fa&O Pham: <br /> 1 k of Alter Facility(or amr&O Month Oay Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Mamammu t Melted Codes(le.,codes ter hazartkxn waste Ireatrnent,dispcsal,and recydng systema) <br /> 1. 1,- <br /> 3. 4. <br /> 20.Designated FacRty Owner or opusior Cenfific8on of receipt of faardous materials covered by the manifest except as riled In bm 18a <br /> 7;47ypad Neese MmM Day Year <br /> EPA Form 8760.22(Rev.124T) Pmviousadltortsamobsolele. GENERATOR'S INITIAL COPY <br />