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2� Generrtor acknovAedges th�t no`matertai change halo occr;;rred efiher In the char�cjertstics or In the process generating the material. i Forrn Approved.OMB No.2050-0039 Please print or type 2.Page or 3.Emergency Response Phone 4.Manifez Tracking Number ® C�_E UNIFORM HAZARDOUS 1.Generator ID Number (q-1q qq �G r WASTE MANIFEST f1L0004220$6 � (900)483-3- 7113 lJ14J�2 Na and ad' Address ,� Generators Site Address('rf different than mailing address) s'Fe� LI Ire k�atr�calion.Inc.-MI5 yvvv A�uorc iti'al �T•1'f'!I'.t Tracy. 95277 I U.S.EP:A ID Number Generators Pho o(20911334-3460 9 3 2 2`2 5 O 6.72nsporter 1 Y ,A D O /eanNarbors E:nvironinentalServices.Inc- U.S.EF'AIDNumbs, 7.T2nsp0rter2 Company Namefl P,LI 7-" ,uS 1� C (� IW►o�'OC/03 It99k S� _ i/j/i U.S.EPA ID Number � B.Designated Facility Name and Site Address U e 1)19 9 1 j 0 1 i 4 3 1 lean Harbors Gitassv Mountain LLC ` S 3 Mites East 7 Miles Borth of KnOUS rrantsville,UT 84029 I► Facility's Phone: (b351394-9900 10.Containers 11.Total 12.Unit 13,Waste Cods 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)) 512 513 j 1-NON-RcRf►HAZARDOUS WASTE.SOLIDS.{EMPTY DRUMS] 00i D t� 0 0 0 3 5 P 0 a z LU 2 w c� 1 3. 4. 1!�SPg�,t N,ndpao s tions and Additional Information 1. 5,5 f � OT P [ CorYr3ct rasa±DEQ bg nenAF3dor!sorters 34erirV trap nnrtPr�trn aan?ratnr',= h:-sh41f rnr nxrmn�a ni it rn nnrtstlnn Rrrtnm+v pack nd Garai t 1Lthor�� 6[1!ltftte!1ta15oger t0 3!gd Dr SUh'ati{!'(e 3Adt!Dnalclassified, -- "he c transport according to applicable intemationaland national governmental regulations.If export shipment and I am the Pr maty 15. GENERATOR'SIOFFEROR'SCERTIFICATION:Thereby declare that h the contents of this consignment are fully and accurately desc bed above by the proper shipping name,a d are packaged, marked and labeled placarded,and are m all respects in proper co generator)orb rfl en a small quant -generator)is true. Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAity genedgment of Consent. � Month Day Year I certify that the waste:minim'lzation statement identified in 40 CFR 262.27(a)(if I am a large quantity Signzttur)ems ..- -------------- GeneratoeslOffe�PdntedrFyped Name, , (4)'o e-1 ❑Export from U.S Port of entrylexd. 16.International Shipment Impo t to U.S. Date leaving U.S.: Transporter signature(for exports only): W 17.TransporterAcknovAsdgment of Receipt of Materials Signature. / Monttr Day Year . Transports[1 Pr nted/Typed Name jj O ,r �^• f�� 6�":..' �=Slgna / ,•fd/�` Month Day Year Z' dra rter2Phnted/rypidLNje F- 18.Discrepancy ❑Residue ❑Partial Rejection Full Rejection 18a.Discrepancy Indication;Space 0 Quantity ❑Type Manifest Reference Number: U.S.EPA ID Number F 18b"Alternate Facility(or Generator) J - v _. I Month Day Year Z' F2,c6a�sTsrw e. W 18x.Signature of A±temate Facility(or Generator) Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous sal,and recycling systems) ardous waste treatment,disposal, 4 2. 29.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest i t except as noted in Item 18a /-i-1,—)� M r Day Year re PrintsdfTyp/e0'ame7f'J1' 1 �" l / DESIGNATED FACILITY TO GENERATOR ( U66�g�df}� aI� EPA Form BJO( R 1 ;7 p rev ro'+r1al�hsP 1 ienrid vAii acclepl Nle waste Ine Jefler�tflt i�511lpPift9• �1�i1I1'i9 i�tlnl--I-- }�P� �„tftsner ha 9 t._aV F wipe