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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tacking Number C WASTE MANIFEST F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) f Thatcher m�.� of C,;SWil 1010 IndUstrtal Cjrf%e Sir ckion, UA.%46 Generator's Phone: e 6.Transporter 1 Company Name U.S.EPA ID Number M%mced 8mi al Trampamt lrtc./DBA A�T'ell 1CAROOM70W 7. rlanspo ter 2 Company Name Technol U.S.EPA ID Number CAROW183 17 8.Designated Facility Name and Site Address U.S.EPA ID Number Parker SallA2 85344 Facility's Phone: W -127-C@1I39 9a. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. I iNort-RCRA, Hazard ;este S- Mi (Bleach Filters) LU 2.-Not) .�.H;%3�SFlYt'tws ..ts!- E�j�Sejli hI Sad S O 3 ort- . _, >Lt2.3rctous astr 'IF�1: � ) 4 oil I? 4 Hazardous 'erste tact t 22111 14.Special Handling Instructions and Additional Information F'"ad NUrI gip.;.:' ( ,; .' 3} EkVf1 TI - -. - ?l EWS6212 THF. _� __ 4) EWS62-13 TIE--� 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,aryl are classified,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 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. Generator's/Offerof,'s Printed/Typed Name Signature Month Day Year VV 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU Transporter 1 Printed/Typed Name Signature r' Month Day Year O e Z Transporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantityl El Full Rejection Type Residue Partial Rejection Manifest Reference Number: F� 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1' 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY