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Please print.or type.(Form designed far use on elite;(12-pitch).typewdter) Form Approved;OMB No.2050-0039 TUNIFORM HAZARDOUS 1.Genera Number'. 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST Ct00022(t0 �a 909x-` d-99f34 0 1 1 1 FLE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) i t r'- r ; i r , -�K i�;r``7 r r s ,:.L�3 r f) �, at}">:Ti_.rt { +'-1S. t 6,f'.j (sb s .'a '✓' �.' .,�1 7l?r-� +,TT,:i ., ., f�. e''%`j! vt}t f`.1'.3f ..'.r �'X1 E, 1'.2)r.9F •� `t<c:�„ <-:.. f},.,�!.Y.,.%n) cif"}C,""f"1,'r +': Y 7`',�t r Generator's Phone: �-U9 A 6 i'- '1900 6.Transporter 1 Company Name U.S.EPA ID Number ItTDY'S7,'P L 'rrL•++S'TF' tYP.TLM3'010Lf; ;'.tttC, rIND98058529:3 7.Transporter 2 Company Name. U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number 1'E'DC'0Tc',T,.t C' 226 E. 13. th Street `rmi .AZ 05365 Facility'SPhohe: � $ 7,t3S 376 A2I2000520304t ga 9b U S DOT Descnption(including.Proper Shipping Name,Hazard Class,ID Number, 10:Containers 11.Total 12,Unit HM and Packing Group(if any)) ,. No. Type . Quantity Wt:Nol. 43:Waste.Codes on gar .ous wa .a aquoa uwa er 331 0 ba" �Tntilsaon). z 2: W 3: 4: 14.Special Handling Instructions and Additional information 1). .ar3raeoxis wart ei base qir it.sign--tL10638-7�7�9.jQiiC�' 15, _GENERATOR', FFEROR S CERTIFICATION: I hereby declare that the contents of this consignment are fully and aocuralely described above by the proper shipping name,and are classified,packaged, marked a'ndlabeled/placarded,and ate in all respects in proper condrtiorifor transport according to applicable international and nalionatgovernmental,regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment con(ormao the temis,of the attached EPA Acknowledgment of Consent. ('certify that the waste trumMization"statement identified in 40 CFR 262.27(a)j f I am a large quantity generafor)dr(b)(if I ama small quantitygenerator)is true_ Generator's/Offer s. nnted/Typed Name bignature Month Day ear ! t 16:International 9hilYmpts ' (- ❑import to U.S. Export from U.S._ Pod.of entry/exit• Z Ttans orler signatUre'for ex orts onl : Date leavingU.S.:,. W 17.TransporierAcknoWledgmentof Receipt of Materials :' Transporter 1 Printed/Typed Name Signaaonth Day. Year. Transporter 2 Print edlTyped Name gnature 66th Day Year F= 18.Discrepancy, 18a.Discrepancy indication Space 0 Quantity O Type j; 0 Residue 0 Partial Re ection ❑Full Re ection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID,Number - :3. :. V �a- Facilit s Phone: 9 w 18c.Signature of Alternate Facility(or Generator) Month Day.g Year 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) 12. 4. Ll20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedTryped Name Signature 'Month Day Year EPA Form 8700=22(Rev.3-05) Previous editions are obsolete: DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED)