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rrl <br /> Please p6rit or type. Form Appruved,OMB No.2050-0035 <br /> UNIFORM HAWDOUS 1 Gerwrator ID Number 2.Page 1 of 3.Emergency Response Phone 4.IlanNael Tracking Number <br /> WASTE MANIFEST CAG17029—^I 909.620-M.CW 019586916 JJK <br /> 5.Generatofs Name and Madeng Address Generetofs Site Address 0 difeerenl then mailing address) <br /> FedEx9M 1000 E F01.13 <br /> R <br /> �Alcoa <br /> C111 uenton,AR 72015 Frencn Camp,CA 55231 <br /> a Generators Phare SO1 8>d�790d U.S.EPA 10 heartier <br /> 46 <br /> 6.Transporter 1 Comparyl Nana <br /> HEC,Inc CAR000 M99 <br /> J 7.Tmsponer 2 Cornball Nana U.S.EPA ID Numb <br /> C? Industrial Wa6te Lnlll atlon,Inc. <br /> s��Facer)Name and Sze Address U.S.EPA ID Number <br /> 1 I AA SYDCOL,LLL AZROCM203D4 <br /> 2264 E.1311111 St <br /> • YIlma,AZ 85365 <br /> F Phar' 92&7153-171515 <br /> ya 9b.U S.DOT Desorption(ircludin5 Proper Shpp V Name.H2wd Class.ID Number, 10.Con anon 11.Total 12.Uric 13,Waste Codes <br /> • HU and PaWy�+P(Nary)) NO, Type Ouantly WL/VOL <br /> N <br /> 1. <br /> p Nan RCRA hazardous WasTe Solid (Absorbent wir Cnaln Woe OIQ / OhlP <br /> s <br /> s <br /> t"'j Non-RCRA Hazardous WWII!Solid (Cleating Rags oebris w/Ctlaln 010 D P <br /> I � 3 V P <br /> j$3 P1or}RCRA nazardous Wa6te Solid(Cardboard Stained Boxes w/OU) DM s <br /> •T 4. <br /> Q� <br /> • •N 14.Speaai nads'9 raavams and Addition l Womr®eon <br /> 90(9) 1x55DM 90(2) 1x550M 9b(3) 1x55OM <br /> F <br /> ® 15 GENERATOR'SrOFFEROR'S CERTIFICATION:I hereby dedare that am oontenls of Itis consignment are tiny and eca,retely,describedabove by the DrePe+shipping none,ab are tlasstlted,packaged, <br /> marked and labekdrptararded,and are In as respects in proper condton for transport according to applicable international and national governmental regulations.N export shipment and I am the Primary <br /> E;ww t W*to the cements of this consignment conform to the terms of the attached EPAAdarowladgment of Coroent. <br /> ]" I century rat the waste nremzation statement IdeflOW in 40 CFR 262.27(a)(A I am a large Wetly generator)or(b)(11 am a small quantity generate)Is We. <br /> F Gene• sherds PnrW),ped Name Ops r ,r si9 More Day Year <br /> e <br /> .e _j 16 ImemaW W Snpmenta110impm.us. ❑bpor horn U.S. Port of entryrexit <br /> w <br /> ? Transporter tpnasue(fa exports aiy). Date leaving U.S.: <br /> •' a 17 Transpicytj ArYu osIisdgrnsnl of Reaipl M Mata a s Day yew <br /> Trmrs tedTyPed Naar,_ Sig <br /> pT <br /> • 5E Tr 2 Prri yped Name Signa are Month Dry Year <br /> 18 Drsaepanq <br /> 18a Discrepancy Indication Space ❑CtueAty ❑Type ❑Residue ❑Partial Rejection ❑Full Rei <br /> f31 <br /> Manrest Reference Number. <br /> 18b Altemete facility(a Generator) U.S.EPA ID Num W <br /> J <br /> U <br /> FacJ,Ws Phone: <br /> • W 18C.Sgnaturs of Alternate Fault'for Generator) March Day Year <br /> a <br /> z <br /> 05 19.Hazardous Waste Report Management Method Codes O.e.,codes for hazardous waste treatment disposal,and recycling system) <br /> • O 1 2. 3. 1. <br /> 1 1 <br /> 20.Designated Facility Owner or Operator Certkason of receipt of hazardous materials covered by the manifest except as irded in Nem 18a <br /> Pnntedrryped Name Signature Monthay. Year <br /> 1 <br /> EPA Form 8700.22(Rev.12.17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEF <br /> Scanned with CamScanner <br />