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Please print or type.(Form designed for use on elite(12-pitch)lypewritec) 00 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number�.r • e ;i 1 S 6 r qui. ... 8 . A,n' WASTE MANIFEST (;: { d ?? ( } 7 .i j: ;�. (;`'OO)49 -:e'�"_19 00�a 1 I r, IVI VV I 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) ,1f0f*kn1 USD -9150J,4 i.s?3t:'t 'rcttzl 1.144 N.FJ Flual Ott"#'tift_Istadir Sutuilril 3 is �: rAs►kbj�; t* mrt 4ttsst.cA900g 2r 1;;, Generator's Phone: k 6 Transporter Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number C,:lowi H airber�Arizona RC 134,0 Wo wt.tiftwkt Meet A Z 00 4 2 l..6 0� AZ 9500 Facility's Phone; (60212%0 GIV6 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(rf any)) 13.Waste Codes NO. Type Quantity Wt.Nol. 1.ON20 1i,D A If t idy:; NY CtMPOUNDS4 WS LJDN.().S.,6-1. OP()i it #1(> I I i3 f1 fA Ey t' Z 2. W 3. 4. 14.Special Handling Instructions and Additional In ormation 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,and are in all i aspects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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. Generator's/Offeror's Printed/Typed Name Signature Month Day 1 Year - 16.International Shipments F- ❑Import to+U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Mate als . Transporter 1 Printed(Typed Name Signature Month Day Year CL 11 (Ki ca Q Transporter 2 Pdntedrryped Name Signature Month: Day Year W r- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quar lity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone:. W 18c.Signature of Alternate Facility(or Generator) Month Day Year 05 19.Hazardous Waste Report Management Method odes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operator.Certifcat on of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY