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Form Approved.DMB No,2050-0039 <br /> Please print yr type. Number <br /> 2.Page 1 of 3-Emergency Response Phone T006108390 <br /> Man West Trackirhg <br /> UNIFORM HAZARDOUS 1.� �ID Nlhmber G B F <br /> WASTE MANIFEST �I.�C;U381tst3�� "� : '-`--: <br /> 5.Gerrerators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> SPttiCiE}1NiET1' ?Jr:; i <br /> t iz638 CO PPEROPO L lb 4D r•raa a.=SCALONIE BELLOTA Rte <br /> L10EN.CA r=ARrlriiNGTON.CA b523U <br /> Generators t - r3T- US.EPA ID Number <br /> 9.Transporter t Company Name <br /> AMERiCfW 1JAt.tE'h' WA51 <br /> 7.Transporter 2 Company Name U.S.EPA M Number <br /> r )til`-C:Lf u-J sulAf.,TY VVO/,iTF SOLIJT;ON S ANO i'Ifl I' 00110924D <br /> 8.Designated Fadlily Name and Site Address U-5.EPA 1D Number <br /> � Efi�-=.Ar'JC�fil t:t)ttf)[34'i�, !LL.. C:AID�fBf!$ti47tli <br /> r i 55 wflT'E'Run;:FD <br /> Fac�itya Prhon - • .,._. <br /> 9a. 9b,U.S.DOT Desmon(Icluding Proper Shipping Name,Hazard Gass,ID Number, 10.Corhtairhers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI Not• <br /> 1. <br /> p #t0 ttf412db.WASTEF3EfRdl.EiuAA CatSTiLLA7ES.NO 5 .; uivi [7uEi# Ck1 r8 X31 <br /> C3AS01 INE, €.7tFSF1 <br /> LLI 2- <br /> tu <br /> 3. <br /> r <br /> 4- i <br /> ( <br /> 14.Spa"Handling Instructions and Additional Information <br /> PROFILE# 756692.02 WATER 8 CAS ERs0128 <br /> EMERGENtC,Y CONTACT'. RONE <br /> 15. GENERAT DR'StOFFEROWS CERMFICATION: I hereby declare that the contents of this consignment are fully and accurately descibed above by the proper shipping name,and a e dasaifred,packaged, <br /> marked and labe"placarded,and are In all res"in proper corifton lot transport according to applicable international and national governmental regulat".t export shipment and I am the Primary <br /> Exporter,I certify that the contents of this wnsi arnernt conform to the terms of the aitactred EPA Acknowledgment of Consent. <br /> I Certify that the waste minimization statement identified in 40 CFR 262.27(a)(ii 1 am a large quantity generator)or(b)(If I a�qVpfmadl quantity generator)i <br /> GeneraVslOfEerors PrWad/Typed Name SignaWre Month bay Year <br /> 16.international SNpMnfs <br /> ❑lmpod to U.S. ❑Export from U.S. Po entryl r <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> Cr: 17.TransportwAcknoMadgment of Receipt of Materials <br /> Tran )ped c' re Month Dy Y r <br /> C <br /> CL <br /> x T ZPn )ped me r nature Month D Y ar <br /> 18. • <br /> 18a.Discrepancy Indication Space ❑ Qwthy ❑Type ❑Residue ❑Partw Rejection ❑Full Rejection <br /> Manifest Rsference Number. <br /> 1k.Alternate Fadlity(ar Generator) U.S.EPA ID Number <br /> J_ <br /> Ca <br /> FacWs Phone: <br /> 18C.Sign�ature ocklernaw Fadkty(or Generator] Month Day Year <br /> a <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1• 2. T- <br /> . 4. <br /> 20.Designated Facility Owner of .Carfifhcation of receipt of hazardous materials covered by the manifest except as rioted in 1 <br /> P&Wd(fyped Name . CA` Signature Month TO <br /> -�V M owI L l <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIG Ep FACM TO EPA`s e-MANWEST SYSTEM <br />