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lol— nrinf nr hi n !Form d-innaA fnr i icp nn n€itp 11 i-nilrhl Ivrwwrilpr t <br />Form Aonroved. OMB No. 2050-4639 <br />EPA Form 8700-22 (Rev. 3-45) Previous editions are obsolete. • DESIGNATED FACILITY TO GENERATOR <br />UNIFORN%fi�S V 1. Generator iD Number2. <br />WAST IFI5V C&%` <br />Page 1 of <br />' <br />3. Emergency Response Phone Manifest Tracking Number <br />Z - :14.000324474 VES <br />5. GP rotors Nam Ma ng dr i Generators Site Address (if different than maiing address) <br />ih� & j � e- `� + <br />Generator's Phone: `"' <br />6- Transporter 1 Company N M U.S. EPA;0 Number <br />V**M ES TatmW Sakdow U.C. N 313" <br />7 Transporter 2 /Compan Name U.S. EPA ID Number <br />8, Designated Facility Name and Site Address U.S. EPA ID Number <br />lfe*U ES T SokdWM U.C. <br />6736 W31 Jaffa St <br />, AZ8SU3 �1ZQ�9'�73 <br />Facslifys PtFn"' <br />9a <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Ccnlainers11. <br />Total <br />12. Unit <br />13. Wasle Codes <br />No, <br />Type <br />HM <br />and Packing Group (f any)) <br />quantity <br />Wt,Nol. <br />ltd,PohTtdonuted bohmAa. fid. 0, UN3 M. POill <br />/ <br />K <br />W <br />3- <br />4. <br />14. Special Handling Instructions and Adddt a Inf�orrmaGv� <br />{{`• ERL i17i `""� r 4>it of Service <br />'Z07 <br />CCC 1 <br />V------ <br />17 GENE TOR'S10FFEROR'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 IabetedlpVacarded, and are in ail raspecis in proper condition for transport according to applicaVe intefoa4onal and national governmental regulations, If export shipment and I am the Primary <br />xporter. I certify that the contents of Ws conslgnrnot conform to the terms of the attached EPA.AeknoVedgment of C xisenl. <br />I certify that the waste minimization stalerrent identified in Oil CFR 262.27(a) (d I am a large quantity generator) or (b) (ift am a VQII quantity generator) is true. <br />Go slOderors Prin€edflyped Name Signature Month Day Year <br />-j <br />i— <br />1e. International Sbipments <br />❑ import to U.S. L_! Export from U.S, Part of enuyfekL L <br />Z <br />Transporter signature (for euports only)' L Date leaving U.S.: <br />w <br />17. TransporterAcknoMedgmentufReceipfofMaterials <br />TranspoRer4 P rlledtTyped Na Sign e o r Month Day_ Year <br />EL <br />r!S <br />4 <br />Transntedli erne / ' 5ignatu .Doth Day Year <br />r 2 6 <br />J� , <br />18. Discrepancy <br />16a. Discrepancy Indication Space ❑ quanfity ❑Type El Residue ❑ Partici Rcgectinn ❑Full Rejection <br />Manifest Relerence Number: <br />18b, Xiomale Facility (or Generator) U.S. EPA ID Number <br />J <br />L) <br />r¢i <br />Facilitys Phone: <br />_ <br />18c. Signature of Alternate Facifity (or Generator) Month Day Year <br />d <br />2 <br />a19. <br />Hazardous Waite Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />Lu � <br />1 <br />2 3. <br />! <br />S. <br />2t), Design Facility O mer or Operator'. Certification of receipt of hazardous materials covered by the manifest except s noted in Item 18a <br />f <br />Printed Nam j 1 Signature i <br />Month Day Year <br />EPA Form 8700-22 (Rev. 3-45) Previous editions are obsolete. • DESIGNATED FACILITY TO GENERATOR <br />