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11 <br />01 n6. mint nr hire X.- A -i -A f-... - effe 11')­ifrhl fi-wifr I <br />11 <br />Form Anoroved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />'.3 <br />2. Page I of <br />3. Emergency Response Phone <br />4. Manifest Tracking Number <br />1 0 09174246 JJK <br />WASTE MANIFEST <br />C;AT�040036644 <br />1 <br />877 _737 <br />5. Generator's Name , and Mailing Address Generator's Site Address (ff different than mailing address) <br />TXAvitto Pfi.rt% -40119 . <br />0. <br />witrz��],V.k Wfek-i <br />(Nh 9,':005 <br />Generator's Phone: it 7 1 <br />6. Transporter I Company Name U.S. EPA ID Number <br />lair!. CAlk 0 a 0 175 4 2 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />Vamefr U.S. EPA ID Number <br />8. Wgnt.jed Facility .Site Address <br />.fj <br />1925 9. Fovtnt Ave-- <br />'fttvn--t,. A1% 88365 <br />Facility's Phone: AZPAiD10117110 11510 <br />ga. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />[-Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />1. V 47 F ic I F IT a R'f;4fi F.a7 a 7 7,7 :a,3 qta. T 7 4, t TIT, F 7.7 77.-14 17,1-.: <br />0 <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />1) 0 ','- " c", <br />5ill lko wMax Ap iL uk-�!,L 1: <br />15. GENERATOR'SlOFFEROITS 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, <br />marked and labelediplararded, 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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />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 generator) is true. <br />GeneratDes/Offemes Printedfryped Name Signature Month Day Year <br />16. International Shipments import to U.S. ❑Export from U'.S. Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transporter i Prin3edrryped Name Signature., Month Day Year <br />0 <br />Transporter 2 Printadrryped Name Signature Month Day Year <br />Discrepancy I <br />I18. <br />18a. Discrepancy Indication Space El Quantity ❑Type El Residue EPar Ual Rejection El Full Rejection <br />Fl <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />LJL <br />Facility's Phone: <br />0 <br />uj <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />!R <br />Z <br />55(9 <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />UJI <br />1 <br />2. <br />3. <br />4. <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Typed Name signature Month Day Year <br />_L I <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />