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F[I'4-6--:r <br /> Please print or type.(Form designed for use an elite(12-pitch)typewriter.) Farm Approved.OMB No.2050-0639 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST i fi €3tIT1ElI r� —` 00 g DAT <br /> 5.Generators Name and Mailing Address Generator's Site Address(if dMarew than mailing address) <br /> MU -49y FREIGHT 8M�5T O E >.yil cs Freight, Inc. <br /> 5415 S, AIRFORT VAT 5475 S. AIRPtIRT WRY <br /> Generators Phone: 1' CA 352OF STM TOR CR 95299 <br /> fi.Transporter 1 Company Name U.S.EPA ID Number <br /> ST RI Y LE s nP r LIAST' 501_LT11 S ING I'lhtSnAA11.t0924 <br /> 7.Transporter 2 Company Namei Y U.S.EPA ID Number <br /> A'0 V kle'o <br /> B.Designated Facility Name and Site Address V U.S.EPA ID Number <br /> 21ST CENTURY I NVIRW TAL MRKME11 OF NEVI M, Lit <br /> 2095 Newla-nds Drive East <br /> Facility's Phone: t I { <br /> 98 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group('d any)) No. Type Quantity WtNol. 13.Waste Codes <br /> ce 1. UKI824 VAUE SHIN HTDROXIIE SOLUTE 8 PHI 10(19112=1181) 1012 122 <br /> XI1 I' <br /> r,u <br /> w z. Iman vistE SOi1I)1I invoinE scLu ow 9 fill 10(jI iTionj M92 122 <br /> a. UN1263 RI15TE PRINT JELRTED IRITERIAL 3 !'SIT $OINI D Lam'! 214 11If11l <br /> X DM P <br /> 4 <br /> 14.Special Handling instruction;and Additional Information <br /> (.1) 1TIUI-112 - ER61154) I2927f MIIII5195 SQ1 121 Ct THI-112 - ER61150 82078l292115115 Solt (3) f-WI IU-92 - <br /> 15. GENERATQR'5f0FFER0Ft%CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dessified,packaged, <br /> rnarked and labeled/placarded,and ate m all respects in proper condition for transport acing to applicable International and national governmental regulations.N export shipment and I am ttre Primary <br /> Exporter,I certify that the contents of this consignment oonform to the terms of the atlached EFAAcknowfedgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a lenge quantity generator)or(b)(ifI am a small quantity generator)is true, <br /> s PtintEedlT Mar Month Day Year <br /> { <br /> htemadonal 5faprner>ts <br /> Import to U.S. ❑Efrport frau U.S. Pori of antrylaxit <br /> Tt&q. rtersigriatore(for exports only): Date.l ng U.S.: <br /> 1-7 TfansixiderAcknowledgment of Receipt of Materials <br /> T spatter typed me Signature Month -P4- <br /> . . .CL <br /> a ea <br /> N>L v� 0 <br /> QTransporter 2Printed(typed ame Signature Month Day Year <br /> T8.Dis ponrq <br /> 18e.Discrepancy Indication Space Quantity Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate Facility <br /> Reference Number:y{or Generator} U.S.EPA ID Number <br /> a <br /> U <br /> LL Factiity's Phone: ' <br /> LU 1 Bc.Signature of Altemate Fadtty(or Generator) <br /> }„ Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. t4 I o l 2 iq 1 3. 4141 <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba <br /> Printed/Typed Name Signature � Monnthh Day Year <br /> MJ A <br /> V f <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br />