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'lease print or type.(Form designed for use on elite(12-pitch)typo..,iter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST _ _ _ , --- _ _ - 008159367 JJK <br /> 5.Generator's Name and Mailing Address Generatorrs Site ACddFess(if different than mailing address) <br /> c SRTEIMS DRi 10(StOOkI011 1ITC'1) _ <br /> ,3 t-;^Nal <br /> � .. <br /> 1375 E <br /> :4;nrft,nr, j �•_ta A . <br /> Generaforr0horte: <br /> 6.Transporter 1 CompanydWdfiiir' '= `== U.S.EPA ID Number <br /> r;'- 6.:-;• _q:,.��_:.s=..icy; �.; --�•,n= r• .._-c-,_.;-` <br /> 7.Transporter 2 Company Name U.S.EP IDTJumlier <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> I E.."ro nnt ! SrC'G--i_ldga31T05402 <br /> 5122 Es:_L StCr2 <br /> Cooll=.aal, AZ `522-8 !SA. <br /> Facility's Phone: _ _ <br /> 9a 9b.U.S.DOT-Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group('d any)) No. Type Quantity Wt.Nol. <br /> Q '•f, <br /> 1. <br /> �Rrt: �r t N �?rsi r t-r _ __.,_. t r, t f �� -_ HI fart' r jN-I irj �� �ill <br /> a � �� <br /> 2 Non-RCRA siaaardlous.1`IV_-c:2- _-;ice <br /> ' r <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Dillard P,rojaot# . 2rJ-V1 1nj pJ <br /> .3.1 (Pf l D vs4 j.�:a <br /> 3.3:3{p?: I ;.uSJebi <br /> 15. GENERATOR'SfOFFEROR'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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached.EPAAcknowledgment 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 /> Gene tor'slOfferor's Printed(ryped Name Signatu Month Day Year <br /> 16,International Shipments <br /> El Import to U.S. ❑Export from U.S. Port ofentry/exit <br /> Z Transporter signature(for exports only):- Date leaving U.S.: <br /> w 17.Transpo cknowled meet of Receipt of Material <br /> Transl Pdntedrrypl Nam Signature Month Day Year <br /> a 4 I� , <br /> QTransporter 2 Printed/Typed Name Signature Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> tai Facility s Phone: r <br /> M <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q • <br /> Z <br /> CD <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1• 2' 3. 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 Mcnth Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />