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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Man est Tracking Number <br /> WASTE MANlFES .,_- ; : l) <br /> F L E-_ <br /> 5.Generator's Name and Mailing Address Generator's Site Address{if different than mailing address} <br /> rr.,, sha115 #€ROI F^.dr r-t61i5#rgZI a' <br /> :)-�_-7A70 .5tO Old Connecticut Path 2203 Grand Canal <br /> Generator's Phona: aminahas. MA 170St e k t o rr CA 95E,0-7 <br /> B.Transporter 1 Company Name U.S.EPA ID Number <br /> 9_0vQjalty Waste So 1 It i rens Inc <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> W:lz•:-.'.4ifie Recovery S steals ICAROOO175422 <br /> 8.Designated Facility Name and Site Address� _ia a Yes, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85:,F <br /> Facility's Phondq 2864PB93 599 <br /> ga 8b.U.S.SPOT Description(including Proper Shipping Name.Hazard Class,ID Number, 10.Containers it.Total 12.Unit 13-Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> I-or, RCRA rtazar-saus waste, liquia (Consular .)Li i: s <br /> r oducts), <br /> LL1 <br /> W 2. <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information 1022 3: {CA 5 t at e R e g u 1 at ed 1_7 C.U i d <br /> `4 19 2.2'f <br /> 15 GEN ERATOR'S10FFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are Fully and accurately described above by th roper shipping name,and are classified,packaged, <br /> maftd and labeledlplacarded,and are In all respects in proper condition for transport according to applicable internationalrnd national governor regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment oonform to me terms of the attached EPA Acknowledgment of se <br /> I cerllfy,that the waste rrunimizaWn statement identified in 40 CFR 262.27(ay(if I am a targe quantity generator)or (if I am a small qua enerator is true. <br /> Ge ratoNON rors Printed Typed Name SignaturF)y b e1 G 1 M t r Month Day Year <br /> 16.International Shipme L]import to U.S ❑Export from U.S. Port ofamryl i2: <br /> ? Transporter signature(for exports only): Date I U.S.: <br /> W 17.Transporter Acknowledgrnenl of Receipt of Matedals <br /> LU <br /> Transporter 1 Printedffyped Name Sign une Month Day Year <br /> 7ransportw 2 Pdnted✓Typed Name Signature Month Day Year <br /> I I <br /> 16.Qiscreparcy <br /> 18a.Discrepancy Indication Space <br /> Quantity Type Residue Partial Rejection <br /> Full Rejection <br /> Manifest Reference Number: <br /> 18b.Allemate Facility(or Generator) U-S.EPA ID Number <br /> J <br /> rJ <br /> LL Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generaku) Month Day Year <br /> 4 <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal.and recycling systems) <br /> LLI f 1-' IA% 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as now in Item 18a <br /> Print, Name r Signature Mo* Day Y <br /> EPA Form 8700.22(Rev. 17) Previous editions are obsolete. DESIGNIIATED FACII IfY TO EPA's e-MANIFEST SYSTEM <br />