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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 Tracking Number] WASTE MANIFEST CA1.x 3354 7 1 1 ' F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 5 r Thatcher�Y of Callibmia Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number '=tf}l!Ci ic4 -P(1d I4G.MB1s1 ArT91'1A o CAFW"7 0 7.Transporter 2 Company Name E.fy"vtr(Xiir, Ted-jyA(Xjim U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number EnNAtorartent Waski am 31915 ind+istliai Lit, AZROOOSZX78 Parker SOUlth AZ 85344 Facility's Phone: � �-G 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) t 13.Waste Codes No. Type Quantity Wt.Nol. ' O 3ici w z 2. w C7 3. 3 ` 4. # t f 14.Special Handling Instructions and Additional Information Pf'alt1 NtRnber 274#15 Dc,44nont Vis, 1) EWS6212 7W.__ - 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 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 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 Na 1eA Signature 4 J Month Day Year International Shipments Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: J7 Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials w Transpo ter 1 Printed Typed Name Signature Month Day Year O CL Z Transporter 2 Printed/Typed Name Signature g Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection F 18b.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number J U L Facility's Phone: UO 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJ 0 1. 2. J. T— ated Ped Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY