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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1,Ge roto ID Number 2 Page 1 of 3.Emergency Rosponse Phone 4.Man'esM§7922 Trackin Numbo WASTE MANIFEST (� 19 4 l�� 1., 2��— �� L3 16 �8 7 9 2 2 JJ K 5 Generalors Name and Mailing Address Generator's Site Address(if different than mailing address) 1he5 1111 I},11ea Generalors Phone:(?Q ri 6.Transporter i Company Name U.S.EPA ID Number George W. Lowry,Inc. C.4 R-03D04701 9 7JTran�pofler2any NameU.S.EPA ID Number � B IDe, I�q_drYbrrhpt} rf� ress U.S.EPA)D,�Iuruhc� 27 y0 E.1cth St. YUMA,AZ 553&S Facility's Phone: 9F8-344-9828 9! 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13 Waste Codes No. Type Quantity WLNoI. X 1. NON RCRA 1,1,62ARDOUS WASTE SOUD (oily absorbent & de s ' U Ni u z 2. w c� 3. 4. i 14,Slgc1aLHarjclligg Instructions and Additional Information 37& USE GLOVES •, Sj / INVOICEV - PhAila-0 1 -740g A145 15.' GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter.I certify that the contents of this consignment conform to the terns of the attached EPAAcknovrl ent of Consent. eertify that the waste minimiza8on statement identified in 40 CFR 262.27(a)(if I am a large quantity ge roto 1 or(b)(if I a a small quank g ator)is true. G ner t r'IOfferct's PrintedrTyped amt In atu. Month Day Year tot 2.y it 17 16. nlematienal Shipments I-- ❑Import to U.S. ❑Export from U.S, Port of entrylexil: _ i� Transporter signature(for exports only) ate leaving U.S.: Of: 17.Transporter Acknovdedgment of Receipt of Materials u Transporter 1 PrintedrTypef Name Signature Month Day Year a t L-0 LU AA 1kc) Z� ZIT orter 2 Prinled+Typed Name Signature Month Day Year cc 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity Type El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b;Alternate Facility(or Generator) U.S.EPA ID Number J U LL Fatuity's Phone: 18el Signature of Alternate Facility(or Generator) -[Mo-n11Day Year S N19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ui 1 2. 0 20.Designated Facility Owner or era or.Certficalion of receipt hazardous materials covered by the manifest except as noted In Item 18a PrintedrTyped Name Signature Month Day Year EPA Forrtl8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)