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GTS.C. 01014. t-'821.. <br /> Please print or type.(Form d ned for use on elite(12-titch) ter. Form Approved.OMB No.205039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number , 2.Page i of 3.Emergency Response Phare 4.Manifest Trading Number <br /> WASTE MANIFEST M000286804 1 S10 6�5-2500 <br /> 004202583 JJK ` <br /> 5.Generates Nam and Maliq Address Generator's Site Address(d different than melting address) <br /> CFJ PROPERTIES <br /> 333 WEST CE371ER STREET FLYI>I<G J TRAVEL PLAZA <br /> NO_ SALT LAKE, UT 84054 1501 N. JACK TORE ROAD <br /> Generowft : 801 296-7700 Atttt: MOH CA 95356 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ADAM SERVICES, INC- <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DZINKIMM <br /> 2000 H_/ALAMEDA STREET CAT080013352 <br /> F Phrone: 310 537-7100 GTTQH, CA 90222 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Now,Hazard Class,ID Number, 10.containers 11.Total 12.Unit 13.V60 Codes <br /> HM and Packing Group(if any)) No. Type Quantity WL Nol. <br /> "NOR—RCRA H&MADOUS WASTE LI=101 <br /> p (CIL i WATER) <br /> r— <br /> o`� 1 TT SO G 241 <br /> Z 2. <br /> W <br /> R? <br /> 3. <br /> 4. <br /> 14.Special Handfing Insbudons and Additional Whrmabon ]L)998 ULMR, 18 OIL <br /> AVOID EYE CONTACT s IISAR RD888R CLGVSS <br /> 003�ITRACTQR: Ct1ARL89 B. THODW CO., INC. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consom ht are fully and accurately described above by the proper shipping name,and are dam,packaged, <br /> marked and labelr dlplacarded,and ere in all respects in proper eonditim for transport actsading to applicable international and national governmental regulabo ns.If egort shipment and I am the Primary <br /> I certify that the contents of this c m ignment conform to the terms of the attached EPA Acknorwiedgment of CakseM <br /> the waste minimization statement ide nti8ed in 40 CFR 262.27(a)(d I ern a large quantity generator)or(b)(dl am a smal quantity is true. <br /> War s Prkded/Typed a Month Day Year <br /> —+ 16.International Shipmentst F Import to U.S. ❑Ezpat from U.S. Pat of erhby/erat: <br /> Z Transporter signature(for exports ody): Date leaving U.S.: <br /> Ix 17.T t of Receipt of Materials <br /> Transporter I PrindedlTyped Name Sign Month Day Year <br /> UR A'L CArrE,"o-/ S 2-9 110y <br /> Transporter 2 ftntedffyped Name Softre Month Day Year <br /> 18.Discrepancy <br /> 189.Discrepancy Indication Spam ❑ Quantity ❑Type ❑Residue ❑Partial Re*#. ❑Fut Rejectan <br /> Manifest Referm Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> FacdiWs Phone: <br /> W I8m Signature of Altemate Facility(or Generator) Morhtth Day Year <br /> a <br /> 2 <br /> H1g.Hazardous Waste Report Managemem Method Codes(i.e.,cedes for waste treatment,disposal,and recycling systems) <br /> C t. 12. <br /> 20.Designated Fad kyy Owner or Operator Certitication of recdpt of hazardous els covered by tlh manifest except asotedinftemiga <br /> Pdnted/Typed Nam Sigmaure Month Day Year <br /> LAA fk0LS -P— �b c1101 <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. UUU 1;ESIGNATED FACILITY TO STINATION STATE(IF REQUIRED) <br /> 10564.1455 <br />