Laserfiche WebLink
, 'i <br />Please print or type <br />Form Approved. OMB No. 2050.0039 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS <br />1. Generator ID umbe <br />O � � O � �, 56401 <br />2. Pa o 1 of <br />� <br />3. E r c , _ spo sep ane <br />y��x�f<a�� <br />9. Manifest Trackln Number <br />� �� <br />WASTE MANIFEST <br />a� $ •„t <br />Genefalors Site Address (if different than mailing address) <br />,3460 NAGLE"E' R <br />T1= P& CIA 6304 <br />Generators P�h1onne: <br />N p p �y <br />6. Trans We (Co5n ��y VMIR0NIA-FNTA),. I" Vf , F' S U.S. UN k.,t PJ 'M ra � ' f� 0 �'3 6 <br />7. Trans p�r1 a/b¢p1]� Y€� U,S. EPAIDNumYb�er�y 9 <br />�.+7 t/-iftE$'"dl�i8.; f'�$',.%a��! irif 4'�,.'9t R,.�16 mc. GAR 0 0 0 3 i 5 4 2 <br />B. DesM% ilitvANatn ad.Sita Ad _ss U.S. EPA 10 Number <br />YUN1A AZ 816365 AZR000521,146 <br />Facility's Phone: 0,2,q)! 4 4- R 82R <br />ga, <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />t1. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nal. <br />0 <br />D M <br />.. <br />z <br />2. <br />LLI <br />0 <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />EMERGENCY t"OWAC , GHEIA I{E0 1-800-424-9300 WAY 9 i EI• N41 NAL: [,ERVK1 GS NAE14GN Baa,11_ 11:1- PROFILE V 9BA . <br />T 691-162623NRS 01LY SOLIDS APPRO I A E HE EQ9J4PMEN'T <br />15. GENERATOR`SfOFFEROR'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, <br />marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable internationaland national govemmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAckno*dgmeat of Consent. <br />,_,.).certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quan8tV'6oneralor) or (b) (if I am a smafl quantity generator) is true. <br />Geperators10fferors Printedped Name;� ' Signafur9 ) Month Day Year <br />$ " L� fJ F,� a 1 ti <br />,j <br />16. International Shipments <br />❑ import to U.S. ❑ Export from U.&-. ° Port of entry€ <br />? <br />Transporter signature (for exports only); Date IeavQ' , S.: <br />W <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Pnnted/Typed Name Signature,:, % Manch Day Year <br />U) <br />Transporter 2 Printedfryped Name Signature Month Day Year <br />F <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantityyp <br />❑ Type Ll Residue ❑Partial Rejection ❑ Fu41 Rejection <br />Manifest Reference Number: <br />H <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />U <br />LL <br />Facility's Phone: <br />i <br />iia <br />18c. Signature ofAllernate Facility (or Generator) <br />Month Day Year <br />a <br />z <br />29 <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />LLI <br />1. <br />2. <br />3. <br />4. <br />20, Designated Facility Owner or Operator; Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Typed Name Signature Month Day Year <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />