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Please print or type.(Form designed for use on eliW(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM NAZARDOUS 1•r6aq@ra)or I�Nu[r�r/L �r+ 2.Page 1 df 3.Emergency Response Phone 4.Mandest Tracking Number <br /> WASTE MANIFEST 1`Fj�11J j ] 1 `� i am 424_sp oommi017616&31 JJ K <br /> 5.Gen s e and li Ad ress t Generator's Site Address(aditterent than mailing address) <br /> GeneraWr's Phone: <br /> 6.Tmnsponer 1 Company Name U.S.EPA ID Number <br /> F1EMMA!ENVIRONMENIAI.8LRVKA-- [W-', C A R O b 0,1,,.7.1 it 1 7 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> WORLMIM REWVERY SYt),I1"M We I I h , J <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number . <br /> YUMAYES LLL <br /> YUAAA AL 86305.1901 <br /> Facility's Phone: 98 344-9828 1A Z R 0 0 0 t ++ 9 <br /> ga 9b.U.S.DOT Description(tnduding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit '+ Waste Cade, <br /> HM and Packing Group(K py))•tt p,�1t No. Type Quantity Wt rM. <br /> 1. <br /> C5 <br /> 3. <br /> t <br /> 4. <br /> 14.Special Hamdr,,Instructions and AddWwol Infomra0on <br /> w #lANlill+ISl1 rCsfi64itlYt 711.1f24fI1AT91t IIS PPH. -UR rAattrw <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 labeled/placarded,and am in al6respects,in proper condition for transport according to applicable international and national govemmenlal regulations.R exportshi{xnerd and 1 am the Primary <br /> Ermkhder,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I cer8fytllatt*waste minimization statement identified in 40 CFR 262.27(a)(til am a large quantity generator)or(b)(81 am a smallquantily generator)Is true <br /> GeneretoeslOHeroes Pdntedlryped NameSignature th Pa 1 <br /> 1 1 1-T t �A ��r' <br /> F-- 16.International Shipments <br /> ❑Import to U.S. Export from U.S. Pon of entryledt , <br /> M Transporter signature(for exports only): P.Iljwrg U.S. <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 FVWatVyped Name \ f Signature hY r <br /> ti ] t tV l <br /> Transporter 2PrniedffypedName Signature th Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial-Rejec6on ❑Full Rejection <br /> Manifest Reference Number. <br /> 1 M.Alternate Facility(or Generator) U.5 EPA ID Nuraher <br /> J <br /> V <br /> r4i Fadlily's Phone: <br /> Lo 1 Be.Signature of Alternate Facility(or Generator) Month Do Year <br /> y19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) X <br /> LO 1. 2. 3 4. <br /> 20.Oesignated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manitestexceptonoted in Item 18a <br /> Printedlryped Name Signature _ Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />