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r enerrtor acknor led es that no m31erta1 change has Mted eWher to the chi c eristles or In the rocese generffitng the material. ' ! 2 g t"" u, p Forrn Approved.OMB No.2050-0039 Please print or type �jaergency Response Phone 4.Manifest Tracking Nuumber -r r HAZARDOUS 1T GeneratorlD Number ::�: 01-4552-700 y�. C UNIFORM O q �. 2 0 4 6 ?0}483 373.8 WASTE MANIFEST � Na and ail' Adtlress 50 " y Generators Site Address('d different than mailing address) 3 5. eneratomire Ir�atrrtcat+on.Inc-3,15 FeU .e.�..��a r S.FI'.VI�E wA��Ak�u o.c utiu - U.S.EP,- 77 A ID Number Generator's Pho��09a 934-34G0I i 6. Trans poder 1 y M ,P,D 0 CJBan lHarbQrs Environmental SeMces,Ir C_ U.S.EF'A 10 Number 1 I^ d IWl of d' 03 it 99k 7-T2nsporter2 Company Name �, T" �"1 J C'l I S T+�r - �lil fl J V U.S.EPA ID Number B.Designated Facility Name'and Site Address ti e 1)9 9 1 j 0 17 4 3 1 jean Haltars cirassv Mountain LLC ` S 3 Miles East 7 Miles Piotth of Knolls tarantsnlle,UT$4029 Facility's Phone: fb35199 -9900 10.Containers 11.Total 12.Unit 13.Waste Codes � 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No Type Quantity Wt.Nol. HM and Packing Group(if any)) �i1'_' 513 1 PION Rr``RP►HAZARDOUS WASTE.SOLIDS.(EMPTY DRUMS) 0 01 D« 0 O Co 3 5 P D r Z 2 w c� 3. i "n. 4. 14 SP ,r N,n> g rfigps andA itional Information � v welO Z P 7U CDfYir3Ct Sai3!n@d b n211?Cnrl,`r]!t(EPS 8G2r.Cjt )I thoritti on!title!trnsnotter to add or suDstit�'te,3d&''tlDrtal tr3nsnurtPr5i un""E"1 r7tnr't: tt:,r,alr rx nirmnra of f ren nr rt apps n name, a d are nnrnrcnr n nr r..rof t 15. GENERATOR'SIOFFCROWS cERTIFIC ATION:I hereby declare that the contents of this consignment are thiintemationalandynat natio govemmentalthe regula proper shippingexport shipment and l am the Primary marked and labeledlp'lacarded,and are in all respects in proper condition for transport according to applicable Exporter,I certify g enerator orb if I am a small quant -generator)is true. Month Day Year that the contents of this consignment conform fo the terms of the attached EPA Acknowledgment of Consent. I ce tify that the vrasta:minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity Signzttur)sem f Generatorsl0ffe�PrintadlFypedNa241 g , 1 (4�eEi J a)� ❑Export from U S Port of entrylexd. 16.International Shipment Import to U.S. Date leaving U.S Transporter signature(for e:xportsonly): /� ° ns /Typed MonVn Day Year Signature./f . W 17.TransporterAcknoWedgment of Receipt of Materials 1 t LU Trarter 1 PrintedName I f �y� Month Day Year 0ft4::A:: er2PrintedlfypedNa eIJ 18.Discrepancy ------------- F-1 iscrepancy ❑Type Residue ❑Partial Rejection Full Rejection 18a.Discrepancy Indication Space 0 Quantity ❑ Manifest Reference Number: U.S.EPA ID Number F 18b-Ali Facility(or Generator) J - v I Month Day Year � FacstitYsPrwc+e: W 18c.Signature of A!temate Facility(or Generator) Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disp3sal,and recycling systems 4 W 2. - 1/11 ?T`ter 20.Designated Facility Ovaner or Operator.Certification of receipt of hazardous materials covered by the manifest ignaturecept as noted in Item 18a Day Year� f� '�, � PrintcdfTyped ameJ DESIGNATED FACIILITY SO GENERATOR R 1 - 7 Rrevi �s a ns ar �bs tete: G;l?(10149!�1110f,17-007 QPW EPP.fast:Bj00l�net hay t + �PtttT[6 far slid moi)accept the araei the generat©r is shipping. _ - ,