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Form ADoroved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />�ou 1 1. Generator ID Number <br />HAZARDOUS <br />UNIFORM HAZARDOU <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. Manifest Tracking Number <br />r <br />- -! L JJK <br />WASTE MANIFEST <br />L) Li, ; ;�' , <br />5. Generator's Name and Mailing Address Generator's Site Address (ff different than mailing address) <br />i C G!, <br />ief oq _F <br />Generator's Phone: <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />MWATUJI wtiv'13114�' <br />.M251 "I OU'l IS MI-A-Li'mu) <br />f:JrTfAmAi" C T <br />Facility's Phone: kill K <br />9a. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />an` <br />and Packing Group ((if any)) <br />Quantity <br />Wt.Nbl. <br />1 JI- I i '0 <br />I JI #J' i <br />0 <br />. <br />T I <br />LU <br />T <br />2. H,4 '7 A f<� I .� <br />'VVr <br />3. <br />4. <br />7 <br />14. Special Handling Instructions and Additional Information <br />9p J76A.Vi <br />s <br />J <br />bt, AZ <br />ri z </ <br />9a. <br />15. GENERATORIVOFFEROR'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 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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Generatoes/Offeroes PrIntediTyped Name Signatus Month Day Year <br />VZ I 1A, <br />A4 k�' <br />_J16. <br />r- <br />International Shipments <br />El import to U.S. D Export from U.S. Port of entry/exit: <br />3 <br />Transporter signature (for exports only): Date leaving U.S.: <br />IX <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Pdntedrryped Name Signature Month Day Year <br />0 <br />CL <br />ZU) <br />Transporter Printed/Typed Name Signature Month Day Year <br />Discrepancy <br />I18. <br />18a. Discrepancy Indication Space El Quantity El Type E]Residue 0 Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />LL. <br />Facility's Phone: <br />8c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. <br />1 2, <br />1 3. <br />4. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br />TMO-ITypedName Signature Month Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />