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I 1111 I !I ! 11111 1 III! I II III ! III [ III it I I i !I I i <br /> Please print or type. Form Approved. OMB No. 2050.0039 <br /> UNIFORM HAZARDOUS I ' m Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> � <br /> WASTE MANIFEST CAL'm`slf04-1j.7t,0 —r' WAS <br /> 5. Gege�ratarslie)ne �dM 4n� d reslrn �L} Ii4� ( ( � F° IE�E � l. 1IC', , ^(? (L elGenerator's;S a ddfgssOjdjffe!jI1anjrTp�l,ngla��ress� . i� <br /> 2829 W WASHINGTON ST p : � { < �' ( ! G <br /> STLC :TONS t+{ Y 150 i 926 u l i t I J : ti t_ r '-15 <br /> Generator's Phone: <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> HERITAGE" TRANSPORT LC — TS HAY 'WAR?` <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. DG k0�1 l E flab j)� i1g Od1rF -rAL ER r i Ci= O U.S. EPA ID Number <br /> 284 E STOREY PRD P- 7D "i 70t, _ � <br /> COOL IDG� j AZ 85128+ 012057 <br /> Facililys Phone: <br /> ga. 9b. U.S. DOT Descripton (Including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Total 12. Unit 13, Waste Codes <br /> HM and Packing Group Of any)) No, Type Quantity Wt.Noi. <br /> I <br /> X 1 ' UN183Oq WASTE SULFURIC ACI05 81 PCI' I ; i( ; j ! <br /> o ( D+ OR '/ e ER % � 1S7 '7 �I <br /> ga j <br /> w X 2' UN2796 WASTE SULFURIC ACID 8 !G11,d R0, <br /> ( Fi tic ) ERb � % S75 ( im1ITH hi.QT fiOPES THAN 10Y i C *j D e Dr ® �Q <br /> 3' NON RCRA HAZARDOUS WAST.= SOLID <br /> DqF 15 J � <br /> 4. ;.InN1 : �. P ' Q, . til ?t 'I ia. fjgSzc..qni. IZ <br /> Rytv <br /> 14, S?fi HI d 'n I G a2bdat"onaIjnfoc6onU 2 4 54F 8_LJr !<1c Gi A ' v[r <br /> Ar. _ <br /> N — . _ . i i j Alm <br /> 15. 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 labetedlpiacarded, and are In all respects In proper condition for transport according to applicable Intemationaland national governmental reguiabons. 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 EPAAckrlowledgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity gonerator) pA Off am a small qua tity generator) is true. <br /> Gen <ger s Pdnt ed Na Sign a Month Day �Year <br /> � <br /> + C 4 1 FAWKfPillw <br /> j . Intematlonat hip ants <br /> i— Import to U.S. ❑ Export from U. enlrylex(l: <br /> ? Transporter signature (for exports only): /aftoiclaving U.S.: <br /> W 17. TransporlerAclmowtedgmenl of Receipt of Materials <br /> ji Transporter 1Pd ed/Typed Name Signatur Month Day Year <br /> o hIXa <br /> 1 Transporter 7130VOyped Name Month Day Year <br /> H <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residuej <br /> ❑ Partial Re action El Full Rejection <br /> i <br /> Manifest Reference Number, <br /> IBb. PRemate Facility (or Generator) U.S. EPA ID Number <br /> V <br /> LL Faclfitys Phone: <br /> wmac. Signature of Altemate Facility (or Generator) Month Day Year <br /> N19, Hazardous Waste Report Management Method Codes Q.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 1 ' H141 2' H141 3 H !t 1 4 <br /> 20. Designated facility Owner or Operator, CerilBcaton of rocelpt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Pdnted/Typed Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 124 Previous editions are obsolete, DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />