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Please print or'type.(Form designed for.use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS' 1.G rleiator.ID Number 2.Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number �+JASTE MANIFEST ( l (, '1 -, ! `;r .4 i' : - ,:, Z' r -0 8 �" �� }47 a. 0r, 5.G$$qQe (tQQis Nwe I-fi Addy�SGepBFa(gr s$tpfaddp Sji�ditfereni than,mailing address) ' iA {i�,�i, ., `>s.'s.h,Rr Ck""R6� : a,T: TNI =17c)"19 7:9,7;9 vARNi^k r=F, 191011SAN17 ftL, >; 17T Generators Phone: ,Sri 5 y fj8tS—.'ja}28 6.Transporter 1 Company Name U.S.EPA lD Number C AZUt+'l':NTA ,4A7,ARWT,Jq .r'"rzr'df i�.{+' s. �Yl9r(p( iii 6lry" 7.Transporter 2 Company Name U.S.EPA 10 Number B.Designated Facility Name and Site Address U.S.EPA ID Number Facility's Phone: (6,2) 4312-5445 ga. 9b.U.S.DOT Description(including Proper t hipping Nania,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit ' 13.Waste Codes HM and Packing Gmup(if any)) No. Type Quantity Wt.lvol. 1. r�3I 2 2. t W XWslur 5 BSEQflE7v?0 , 3.OISFi+ A—'MC-ATM—=NT OR MS&CROSBY S.OVMTON,INC,-O!'St,1 ,TFS THE FACU.ATY U I,Pr I r9,CRVAJ`F.D TO T1frM-BY r,-m nuAFTt wA-r OF TOXIC SUBSTANCE CY3N MOL,TOCE7T .R - -• --- ❑2 L,VVIi LONRr--rrAl.PR(Y,TF4710K AGENCY D4 ACCORDANCE Wr1T/THG PPOVt'slo"m v . )70;.soV1'CE CU"15FRVATION'AND RECOVER:'ACC OF 1976 .. S.'+ & (NMTrON HAS AI.:_ OF'7}:F..NECLSSA Y: 4'':5hhir17'Tti)ACY:GP'4'T1tiL k.r----41 7rD WAFTU AND AIA 11M WASTE HAS BrF UAWOr• - �(Y.lnRblVfSl,Y 14 Special Handling Instructions and Additional Information f fP, X.. -! f..t r At;.4 't fir'';{ lFsi':S )�}' .' A:titfi 'Tl'r'yF r ' f.'• KIM-' F~(�tC.i'S.•jTl" i.it �.'+�.1'11.�f, . r+STt;T. ]f)' i'�l-- i T. t' � ' t3Clt;rK- 4- 30 15.'GENERATOWSlOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified;packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I cedity that the contents of this consignment conform to the terms of the attached EPAAdcnowiedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(if I am a small quantity generator)is true. Genemtoes/OfTerods Pdnted/Typed Name Signaturel Month Day Year 03 —i 16.Intematioqal Shipments �... El Import to U.S. ❑Export from U.S. Pore of entry/exit: Transporter signature(for exports only): Date leagi9g U.S.: U.1 17.TransporterAcknowledgment of Receipt of Materials f Transpo ter 1 Printediped Named` r.' a Signature t Month. DaY Year ar QTransporter PrtntedlTyped Name Signature Month Day Year P- 18.Discrepancy 18a.Discrepancy Indication Space El quantity ❑Type Residue ❑Partial Rejection ❑Ful!Reiecticn Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S EPA ID Number J JUN Facilitys Phone: W 18c.Signature.ofAlternateFadiity(orGenerator) pI 3 Month Day Year a NVIRU�i�v� � Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems 2. 4 y i 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18g Prinfe yped Name Signature :i E r { {nth Day Year EPA Form 8700-22(Rev.3-05)' evious editions are obsolete. DESIGNATED FACILITY TO GENERATOR