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Please pW or (Form designed for use on a 12' ftcll ter. Form Approved.OMB No.20600039 <br /> UNIFORM HAZARDOU8 1. for ID Ndmber 2.Page 1 of 3.Erna ncy Response Phone 4.Manifest Tracking Number <br /> WAB,>i MANIFE8T pt�oa' 59 �b , - � 016711232 JJk­'-.--* <br /> 5 GpTR <br /> e'and MOng Address E. Generators Site Address(If dHferent then-mai address) <br /> NIS cN1;`�as �a %WtKt <br /> Generala a Phone. bb's; S641, 2s W 1N t14 <br /> LA a152a3 <br /> S IRONMENTALSERVICES INC• U.S.HPAtR:0-0 <br /> 7 T U2MBE n Nemo U.S.EPA ED Number <br /> 'WRECOVERY SYSTEM INC :. C-A,.R,0 0,70A: 7 54 2 2 <br /> a4 fFL .L� ana site Address U.&EPAID Number <br /> :13TI4 ST <br /> 1UlNkAZr85386~19011 <br /> 92t3. 344-982$. .: .�... .A Z A 0 0. 0- 5 1 5 9 2 4 <br /> g,"I 9b.U.S.DOT DescWpdDn(including Proper Shlppfng Nam,Hazard Class,ID Number, 10.Containers 11.TOW 12.Unft 13.Waste Codes ..... : <br /> and '1-1.tg�P(dam) No. Qlr (ty WtJVd. <br /> Jak <br /> 49 F4FFE <br /> 3 � <br /> - soR�IrjRCAKWUUb 113(OILY 223 <br /> As : �� . <br /> 4. <br /> t4.- Ffend➢rig+ ons end Additional tnfomu►tfon ,. <br /> Ob) HAMUMMIM40E[FLTLAMMANDUSEPPE--ERbmftad <br /> 15: GENERATOR'BIOFFEROn CEMFICATiON: I hereby&dste that the contents of Els consignment are f*ana aoaeataty described above by Bte pkoper stripping name,and are dassffted,packaged, <br /> marked and labelad<p<ecarded,and are in all res"In proper oonditk n for transport acoording to applEr"Irda<rta6o Wand national governmental modabons.Ifexport shipment aAd I am the Primary <br /> EVorter,I cwW that the conteela of ft consignment aonbrrn to the tams of the attached EPAAkknowlodgment at Certsenl. � <br /> I certify that tie waste mb imlExtion statemartt kterkfffed In 40 CFR 282.27(a)(if I am a large quantity generator)or(b)(l1!0a eme9 quartttly generstor)is true. c <br /> Ge forst s me Sig re Month Day Year <br /> AA <br /> �.r 16.Intemallf ❑Shlpments ry Import 10 U.S. Fl Expert horn U.S. Port d-*A,Transporter signature(for exports only): Ieavbtg U.&- <br /> 17.TransporterAcarowiedgment of Receo of Materials ; <br /> � Transporter 1 Pdntedll'yPAL��•`� l,.-�1t�1� signature �;; ►,H,orn1 Day <br /> vai 1� �' IVA <br /> Transporter 2 Pd 96T ped Nam SEgnatu f Y _ Month� lDay� Year <br /> ct <br /> 18.UscreparKy 1 <br /> 18a.Discrepancy Indkx(ion Space ❑ C.'" ❑Type ❑Resklue bl Pardal Re)ec ton ❑Full ReJedton <br /> ManKest Reference Number. <br /> 18b.AEtemate Faclly(or Generator) U.S.EPA ID Number <br /> V <br /> ua. Faclitys Phone: <br /> a 18c.Signature of Alternate Factity(or Generator) Month Day Year <br /> x <br /> 19.Hazardous Waste Report Management Method Codes(I.e.,codes fix hazardous waste treatment,disposal,and recycing systems) <br /> 0 1. `^ 2. 3. 4. <br /> Ishw i <br /> 20.Designated FaclUtyy Owner or Operator.Cer5cstlarn of reoeipt olhazardous materials covered by the manliest except as noted In ttem 18a <br /> NntedMyW Name r Signaturenth Day Year <br /> 1 4,1 A 1191 <br /> EPA Form 8700-22,R64. 5) PreloO§ed ns are epaolete. DESIGNATED CILITY ESTINAl10N STATE(1F REQUIRED) <br />