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V V Gr'w—r <br /> 5.Generators NNpemC SlidyMaitir♦p Address Generators SAe'Addrees(d;Qfiferaimtha .g address) <br /> 994.1� <br /> S M8?.N 5'i . <br /> TF�11" CA 95337 <br /> Generatorsj+ti'orie: ' 209-465' —5181 <br /> ti A <br /> B.Trans rT NameU.S.EPA DNumher <br /> tiA�£1'Y K� .FN �'VEiL-Pisa IhdC. TXR900050':30 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SWFTY-K1_€FN SYSTEMS IN U. D No .r „ <br /> 172.2 COOPER CREEK ROAD <br /> DENTIN , TX 7620.8 <br /> t34Vt-4;13--`i"0Pi 'f%))077£i033 Y 1 <br /> Faaldy's Phone: I , <br /> ea. 9b.U.S.DOT DesmtptionQrrJuding Proper Shipping Name,Hazard peas,ID Number, 10.Containers 11.Tale) 12 Unit -13.Waeb Cadge <br /> HM end Packn9GreuP(dem)) No. Type Quantity uantity WUWI. <br /> X 1 t!ABTE GRntit_IP1F, MIXTURE D14 �J fiCAO. D008 :„ t {, , <br /> U 11203 F'fi T I J <br /> Ei-e OU79 <br /> X. Z t7t' M-7-6 dh :.TF..BAL X96 l�t3WF�YA6.I Phi _ « <br /> F1.A►AM�r+: t.��ttr�, -Pk-o<-.�.T...� o�t��-1_.��_._ _ .. w_ ..`... . <br /> 4. 1., PGT t. •+► . .._ — OUTS <br /> 3. <br /> al riding <br /> cboaandAdditione Information ,Q <br /> a <br /> fi <br /> SK SHIP#2@4491064 5 45405KI 1IMI7776!S#'i <br /> f f e P"'r71T•a n <br /> 24 HR#128yg�E' ..... #'1—S� <br /> ?4 HR EM NGFiyrY #1-801-468-1760 t8AFcAI07AEEN. CAlrA , 4138) <br /> K�. A f ^ 7 llc = 3� F T R• A 41 f 7. A 2 ®. -. - <br /> 15. GENERATOR'11110FFEROR'S CERTIFICATION: I hereby declare that the contents of INS consignment ure fully and accurately described some by the proper Shipp'" lei Al nsleSaified;padmlied, <br /> marked and labeledlplecanded,and are in all respects in prepercondillonfor senspon according to apph blentemaganaland nafignalgovemmentelregulatlons.li—portsh'yurenland lam%Primary <br /> Exporter,Icor8fy that the contents ofthle consigmlenl confom)othe terms oflhe Site EPAAc nl of Consent <br /> Ice"that the waste mombation statement Identified In 40 CFR 292,27(a)(I l am alage quensryg r1 or(b)([ft am a amid Willy generator)la We. <br /> Genaalors/Mro`S,Pdnted/Pyped Name Sig re / i <br /> Mash Dey Year _ <br /> t6.lmemedonal Shlpmenla ❑usilonto UB ❑E+pon San S. Portoferryladt/ - <br /> 'Rensporlerslgnature(for sports only): Date leaalng.U.S.: <br /> 17.TrmiloS rlerAcluawledgmenlaf Receipt of MateriUa <br /> a1 Pdnted <br /> Month Day Yer <br /> nomfrypeNate Sig] <br /> x <br /> Transporter 2 RinladlTypad Name - Sig ature Monti Day Yea,... <br /> n <br /> 18,Discrepancy - <br /> 18a.Dlsa9pancy Indication Specs ❑ Ouantiy ❑Te ❑Res P e1�y��] ❑Full Rejection <br /> 18bAtemare Fachity(a Gmerebr) V.S.EPA ID Number <br /> JUL :112014 <br /> Fecllfiys Phone: ' <br /> 18c.Signature ofAdemete Facility orGeneraa <br /> MVIROUMPKITAL HEALTH t <br /> 19.Hazardous Waste Repan Management Method Codes 8.e.,codes for hazardous wasU treatment,disposaij and recycling system) ` <br /> 1. 2. 3. '4... <br /> 20.Designated Facility Dwneror0peator.Cerdfmahon of receipt of hazardous materials covered bythe men at except as nded n Item 185 <br /> rd dayped Name re Bare Month Day, Year _ <br /> i . <br /> Form 8700-22(Rev.3-05) Previous edidons are obsolete GENERATOR'S INITIAL COPY <br /> 944:ir.-1211 <br />