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Please prim ortypei(Form designed for use on elite(12pltch)typewnter) Form Approved,OMB No.2050 GOOD ' <br /> UNIFORM HAZARDOUS 1,GamnaliID manner 2.Pagelpt 3'E rgency Response Phone' 4.M011eking 09umbar FLE <br /> WASTE MANIFEST { sear. c: <br /> 5.WASTor's Name and Mailing Atltlress - - Geoemmr Ssuav, dtil JlM�Man mailirg etltlress7 <br /> Pod.d Stoc triad - <br /> 7101 WasFirlptorl Ame. <br /> 6T° d a 116201 <br /> 6 TrsnspoMrldandies'...a- 4-33 U.S.EPA NuIMer <br /> Adial Chemical Trarfsport W. (SV) CAFW0007OW <br /> 7.Traosporer 2Company Name U.S.EPA IC Number <br /> Wa1dMi Rgw.gFy Syetom, Inc CAR000175422 <br /> 8.Casgrefetl Facility Name and any Mice. U.S,EPA IC Number <br /> 22730E 1511LSt A2R000515424 <br /> Ytmad AZ 85365 <br /> Fauoy hare <br /> ga 9b.US.OOT Dai('mclutling Pmper Shppl.,Name,Haaard Class.ID Numbe[ to.Coebinem 11.Tobi 12.Wit 13.Wass,Cotlm <br /> AM aMPackirgk2'oup(Neny7) No. Type Quark, Vft= <br /> o 1'idlRCRA Haaardous Waste,SOK(O0ySOW - ,,�� OM 1 1 , ( p 352. <br /> our <br /> w wdid CR pHahwead. sWasie.liquid.(Ogl Rters not crushed DIM . _ p 223 <br /> o adrwbtc p�cfm«{,ticbFis) L1Y13 <br /> 3. <br /> C ti._..,. G.., <br /> 1a.speeal Hantlfing lrsfrus8onaarA Asailiddal brbnmhon 147884 Del# D1713M <br /> 2) 176883 POY-" - ^� f, <br /> 15. GENEHATOR'SNIFFEROR'S CERTIFICATION: the ederefhar Meanbnfs of lM1ie mnsignmenf arefullyandasuas,tyTes etl' ve by ne mpeishippng name,and are dmarfied packaged <br /> marked and larmadmaa.Nel, riles,trail mrWi in pmpttmntlifiootor VampoM1acro'ding mappinceble ineematlmal and raNnalgovemmenbl re,masons.Iferpan shipment and l am Me Primary <br /> ExpMa,l cttfifyfhef the aMenkof Mk oansgnmenlomfdrmm Me s,res Mitreapa[Med EPAAdmwdedgmanlol Lorean <br /> I mrfiN that Mewazm miNbvagonsfafemeMideMified ing0CFR262T!(a)ptl amalerye quaMdy gmemmr7 or( )(file small tygemmbr)kVue. <br /> area amts dQnbk - Mre re / aY Yeak <br /> ^� <br /> 1 16.miesmar Onal Shinners <br /> 'r ❑ImpoM1m U.S. ❑ExpMfmm US. ortplenlrylexiC <br /> Trans m, nacre Amax r5 any): Das,lead US.: <br /> a ad <br /> 17.TranapwrerAckncrvletl9reenlol RemiprMMef¢risk <br /> Transporter,l p"Yea TypeJNme, 9re uredid Day <br /> a <br /> I`am9e Ryped Name donee. Monty Day a <br /> 1 18 asdy <br /> I IM DI mc,I1dicag.Spam ❑ Oam... T . ❑ e ❑ <br /> ResiduParcel ReP.Bfial El Fin Rejection <br /> MiReference Number <br /> 18b.Assured,Fadlity(a Ganendim U.S.EPA ID Number <br /> J <br /> Q <br /> oFadll 's Phase: Month <br /> ou 18a Signature mrkinrnare Facility(or Demands) Day—Year <br /> 6 <br /> z <br /> H18.HaYarroa W eRepon Maregemem Mellwtl Ootles Q.e.,mtleskrharallouswasb Veehnent tliapoaal,andraytlillg sysram6) <br /> 211.Deegnaf <br /> PName Sgn <br /> 1 YDµaIaa LLCeramr GarGfiL9MXI0ff&21p101MIDNOLLS r11af4YlaamVGRd by MO m Sgure%LEpf 84 r,Ofad in than 199 imted!fYPatl Name aWre MpnM De Y Y r <br /> �e.arp Ol l <br /> EPA Form 8700-22(Res..345rTrevious editions are olarolete. _ DESIGNATED FACIhIT)(.7O Ca,6J1EI)9Tj)R <br />