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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone 4 �r <br /> WASTE MANIFEST -7 _ -r- MM-5-727 FLE <br /> 5.Generators Name and Mailing Address Generators Site Address(d dii4erent than mailing address) <br /> IS EKVPONWNTAL + <br /> 44150 S. AY 99 <br /> S TnK CA OEM 5 <br /> Generators Phare: <br /> 8-Transporter 1 Company Name US:EPA ID Number <br /> Owmmd Tit kZ.108A ACTOnWo CAROGM17W2,40 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> System, b-m CAIRIM 154,22 <br /> 8-Designated Facility Name and Site Address U.S-EPA ID Number <br /> YWM <br /> E 1%St <br /> .,1524 <br /> 1f1I9t9a7, AZ SSM <br /> Fad s Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Stripping Name,Hazard Class,ID Number, 10.Conhdirlers 11.Total 12.Unit 13.Waste Codes <br /> HM and Paddrig Group(d any)) UNo <br /> No. Type Quantity Wl. <br /> C,,, wo <br /> O tj - <br /> W 2 Wall-RCRA H &MS a51le SOU( .D 1 <br /> 3.NOW RC HaZatdms Waw LqWd(011y``Vater) fir' <br /> a Mon-RCRA Waste Uqdd f)Ate4 � - - <br /> 10-.Special Handling Instructions andAdditional lnfamatiorr <br /> Pr4ed Mrdber MOB D=HneM DV=7 <br /> 1) fVl4019IWv aE rV4/ 11 it S'S 0T H 3) 1914 i -,011 f► X 6Tfj <br /> 2) 1914M RBY--� Aj i914 RBB-QQ X 0T•/1 <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are Tully and accurately described above by the proper stopping name,and are classified,packaged, <br /> marked and labeledlplecarded,and are in all mspects in proper condition for transport according to applicable intematronaland national governmental regulations.If export shipment and I am the Primary <br /> Fxportar,I oe - that the contents of this oonsignunent conform to the terms of the aeached EPAAdmowledgment of Consent <br /> I certify that the waste mtnim®tion stotement identified im 40 CFR 26227(a)(d I am a large Quantity generator)or(b)(di am a s�gall quantity generator)is true. <br /> GeceratorslOAerors Prarterlliyped Name Signature f �. Month �Day Year <br /> J 16.international Shipments ❑ ... <br /> Import to U.S- ❑Export from U.S.U-S- PoR of emtrygxct _ •-- <br /> Transporter signature(far exports only): Date leaving U.S.: <br /> W 17.TransporterAcgwvdedgrrerd of Rece001'Materials <br /> F Transporter 1 Pr ffyped Name Sgnatu Month Day Year <br /> CL rX. it," <br /> Transporter2PrintedffypedNam {Sig - re Month Day Year <br /> F �f <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ElQuery ❑Type ❑Residue El Partial Rejection El Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alrerrtts Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL Facility's Phone: <br /> W 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1 2. 3. 4. <br /> 201��� <br /> Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as Doted in nem 180- <br /> Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />