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!aS9 print or type. {Form designed for use on elite 12 -pitch) typewriter.) <br />UNIFORM HAZARDOUS 1. Generator ID N4mber <br />WASTE MANIFEST C A L 0 0 C 9 19 f <br />5. Generators Name and Mailing Address <br />PAP MACH INLRY INC - FREI'lGH GI -IMI" <br />96218 E.E. DORAC)0 <br />FREIVCH CRIMP CA 9523.1. <br />Generator's Phone: 209 <br />6. Transporter 1 Company Name <br />VVOPLD OI L EI'JV POIq `4.'Effl AL SERVICES <br />7, Transporter 2 Company Nam <br />VVORLDINIDE RECOVERY SYS'll-NI INC. <br />A nacinna!pd Fnrility Name and Site Address <br />a <br />4 <br />d <br />LU <br />W <br />z <br />w <br />0 <br />I•UI�VA Yk-3 LLS_ <br />2730 E 13•f Id :31 <br />YIJM;A AZ 851365 <br />:acility's Phone: is s <br />ga Sb. U.S- DDT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (if any)) <br />1.IVON-RCIRAHAZARDOUS V+VASTE. SOLID { DII-Y SOLID, PAPER FILTERS) <br />3- <br />' a" +)n <br />Form Approved. OMB No. 2050.0038 <br />response Phone 4. Manifest Tracking Number <br />2:T_:9J001 017468924 JJK <br />Address (if different than mailing addressl <br />X21 S EL DORADO S PEE E <br />CAD028217036 <br />U.S. EPA ID Number <br />A"Z FtC)c7E. 5.5,15924 <br />10. Cantainsrs 11. Total 12- Unit 13- Waste Codes <br />No Type Quantity Wl.Nol- <br />EMERGENCY f'Clld' :,CT : Cl f Chd'i f?LC i. SOO 7�-a,;CC l'UCii :� TI::'rov! li'dAL GI--. I• ES „ ";0 l I-1 I ::L'' ':I_-': N ?SPAT 0:i,.ra <br />OILY,"30LID. PAPIER FILTFRS x x APPROPRIA`i E PPE EQUIPMEsVT <br />15. G E NERATO R'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 Is beledlpiacarded, and are in all respects in proper condition for transport according to applicable Intemationa€ and national govemm ental regulatlons. If export shipment and I am the Primary <br />Exporter, 4 certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />1 certify that the waste minimization statement Identified in 40 CFR 26227(a, (if I am a large quantity generator) or [b] (if I am a prn or is(rue. <br />Month Day <br />[ watnr`V0fferors Printe Iffvned Name I Si h � .. - _. n . <br />=-A 16. Intamationa' Shipments <br />r ❑ Import to U ❑ Export from U.S. <br />Port of entrylexit: <br />-S. <br />Z Transporter signature (tor exports only): <br />Date leaving U.S.: <br />10� 17. TransporterAc',xnowtedgmenl of Receipt of Ma`.erials <br />- Transpo rTyped me Signature <br />( <br />0 �� <br />QTransporter2 ntadItypaU N e Signalu e <br />- <br />{Pri <br />18. Discrepancy <br />184, Discrepancy Indication Space ❑ Quantity ❑Type <br />❑ Resi&, r <br />Manifest Reference Number; <br />1 Bb- Alternate Facility (or Generator) <br />J <br />5 <br />tE Facility's Pnone: <br />� 18c. Signature of Alternate Facility (or Generator) <br />r— <br />a <br />z <br />0 ig- Hazardous Waste Report f4anagemen( Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyc`inq systems) <br />2 <br />0 1 <br />3 <br />r <br />U <br />20. Design d Facility Owner or Operator: Certification of receipt of hazardous materiats covered by the manifest ex <br />noted in Item 18a <br />Printedf ed Name• r % Sig .atu)e <br />e <br />❑ Partial Rejection <br />U.S. EPA ID Number <br />Month Da Year <br />]l I & I l(? <br />Month Day Year <br />/i ,is, VT <br />❑ Full Reisetion <br />Year <br />11 V <br />LLhdjj..D <br />�r r <br />VL <br />EPA farm 8700-22 [Rev. 3.05] Previous editions are obsolete. D [_=ham7i ELS rflbi ,+ a o MST]NATION STATE [IF REQUIRED] <br />