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Please (Hint or tvoe <br />EPA Fo7rm 8700-22'%R-ev. 12-17) Previous editions are obsoley DEAGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />1-7 <br />Gen <br />UNIFORM HAZARDOUS I I t"" ' ' ". -, 2. Page 1 of 3. Emergency Response, Phone <br />roan Approvea UM13 No. 2050-0039 <br />C. Manifest Tracking- Number <br />WASTE MANIFEST CADW2471856 888-7&ro-7225 <br />0 8 3 5185 FLE <br />5. Generator's Name an MA- —erierat&s Si* i, <br />Size AddTss 'if different than mailing address,! <br />GLJNMRT &ZIMMERMAN CONST DIV. <br />E FOURTH ST <br />T�sPQN, CA %--W <br />Generato Phone, <br />6. Transporter i Company Arne, <br />U.S EPA ID NumbB <br />ADVANCFQ CHFLOCAL TRA PC)RT I I <br />7. Transporter 2 Company Name <br />U S. EPA ID Number <br />Erry4ronmainital M@nMqML"TK N <br />_vWas <br />CAR"183674 <br />8 Designated Facility Name and Sate Awress <br />U S. EPA 10 Number <br />Emmental Waste SCJUft% <br />31915 Irdustrid Ln. <br />Parker South AZ &53" <br />AZR000520478 <br />Facilil (s Phone Q2MhQ7M- 7 <br />9a. <br />9b. U.S, DOT Description ;including Proper Shipping Name, Hazard QW, 10 Number, <br />10. Contair>ers <br />11 Total <br />12, Unit <br />HM <br />and Packing. Group 'if any)) <br />Quantity <br />ftliv, <br />13. Waste Codes <br />Type <br />Ix <br />'NowRICRA Hazardous Wasie Sold (Oily Absod)enQi152 <br />DM <br />P <br />6 <br />NoD-RCRA Hazardous Wasie Solid (09 Furs) <br />V - <br />417 <br />P <br />?.23 <br />3, <br />4, <br />-- — -------- <br />.. ........ <br />14 Special Handling Instructions ar,,1 Project Nufftm 608912 Doctilmot D7$7765 <br />1) EWS13318 Gueal�..A <br />2) EWS27039 G <br />15, GENERATOR'$/OFFEROR'S CERTIFICATION: ne-et y de" , :are lina! the concerts o? this consignmen: are, lu.iy and accigaiety described above by the proper shippingname, and aredassifiiid vickal;6d. <br />marked and labsiad;piacarded, and are in all respects proper condition for transport according to appiicabie international and national governn,arlal regulations. It export shipment and' i am trie Primani <br />Exporter I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consarl. <br />I certify that the waste minimization statement dentifed in 40 CFR 262,27(a),Iif !am a large quantity generator,, of (bj 6f l am a small quant y generator; .stn e <br />C-4 raWs-0flerors PrintediTyped Nam 5gnatura <br />Month Day ye , <br />18. Internaonor Shipments <br />............ <br />Z <br />mw,,t to U.S. Export from U.S. Poll of enryexit: <br />Transporter signature i;for exports only). Datf-eavin,g U.S.. <br />C4 <br />UJI <br />17.Tw.spof*ierA(;hno�tAe&jtre?)tofReceipt ofmatensis <br />I-- <br />Transporter 1 Printed.,rTyped <br />R <br />Transporter 2 kn4r Noma d Na1natu <br />n144 <br />Dav, <br />flit All <br />18a D+Screvancv Indication Space �7 <br />Q 16ly yl�v <br />Full Re,*ction <br />Manifest Reference Number: <br />18b. alternate Facility (or Generator) <br />i S. EPA ID Number <br />ILL. <br />Facility's <br />0 <br />W <br />Phone. <br />18c. Sqnalurp of Attarri aie Facility for Generator+ <br />ll - <br />I <br />f enih Day Year <br />- <br />19. H rdous Waste Report Management Method Codes a., pode-tc, t%azatc :swis!i?lrrlatment d3posal, and recydhng s)te <br />s rns <br />LLJ <br />1.3. <br />2 <br />a. <br />Desgrated Fac,4fty, Owner or Operator: Certificat on of receipt of hazarrous malenais covsrad by lhe rr".."Oest except as noted In 'tirn <br />NaIme,,tur <br />0a <br />ru 01 1 'A <br />EPA Fo7rm 8700-22'%R-ev. 12-17) Previous editions are obsoley DEAGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />1-7 <br />