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Please punt or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Njapifggtc�j�rg ptug)be <br /> WASTE MANIFEST CAR000078204 1 77225 VA 1 *J�flub�g 7 3 F L E <br /> 5.Generators Name and MallEng�Address GeneWces Situ Address(if different than mailing address) <br /> t,8�t�]RIt i Nmural Prockiicls <br /> '1250 E, Lab>�oa1d as[Ayt�- wtiintoorlp.orn <br /> I.ithonp, CA <br /> Generator's Phone: <br /> 6. ra s rter 1 C nyIN U.9.EPA 10 Number <br /> 1� irtQlmyn 1,01;Transport Ir odDIBA AQ76 n p CAR00007QW <br /> 7.,gnsyo ny Name U.S.EPA ID Number <br /> 1IV[[NN11 �ar owry System, the ('AROW17'5d22 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Yurrsa YES, LLC AZRO0 1` 24 <br /> 11;3[]E. 'I N, St <br /> Yt im=j, <br /> AZ 8!>. -i <br /> FacililysPhone: g29'1 28 <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(if any)) No. Type Quantity Wt.Nol. <br /> 1.Non-HGHA.Hazard(ws WaMe,Liquid,(Flex pint) <br /> 0M €' '35 <br /> O <br /> z 2.I (Wk- -RAthlazaardwc�Waste lJquid. (Oil tillers nc-A crazy and 7.23 <br /> 0 &wl Citi)debm—) <br /> 3. <br /> 4 — <br /> 14.Special Handling Instructions and Additional Information 1-'f1 ea NUtrltm' 2413134 L)OCU"ient#: on9934 <br /> 1) 176707 GAY-_ <br /> 2) 1744M(AY-� <br /> 5. GENERATOR'SIOFFEROR'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 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)(ifI am a s fnall quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signa ure Month Day Year <br /> 16.International Shipments <br /> H ❑Import to U.S. ❑Export from U.S. Port of entry/eXit: <br /> ?I Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Printedrryped Name Signature Month Day Year <br /> O <br /> CL <br /> Z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity � ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection I <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q1Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> c 1. 12, 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 /> PrintedfTyped Name Signature Month Day Year <br /> EPA Form 8700.22(Rev.12-17) Previous edltlartis are obsolete. GENERATOR'S INITIAL COPY <br />