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Please print or type-form designed for use on elite(12•pitch)typewriter,) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Man eat Trackfn Number <br /> WASTE MANIFEST r-AL 5717 1 41 -823-8772 L <br /> 5.Generators Nam and Mailing Address Generators Site Address(it different than mailing address) <br /> t IE .SAL tel( 'iii Alit MeM ftt$r3#1CH <br /> VWS'E( C1 <br /> GerrertarsPtiane: .: +` <br /> 6:rranspalert ompanyNama "U.S,EPA•tONumber* <br /> Urn Pkffip Linea C( <br /> 7.Transporter 2 Company Name U.S,EPA ID Number; <br /> 8.Dasignated Facility Name and Site Address U.S.EPA ID Number <br /> EC`Dl n*arrwnantal t1TCW301LOf <br /> 9191 West Hue 121 <br /> Fad(i[ys Phoria: <br /> >4-1444.31 East calim,UT M620 LMA <br /> 88. 9b.U.S.DOT Description(indudfng Proper Shipping Name,Heard Class,ID Number, 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WIIVOI. <br /> E <br /> a <br /> r <br /> c, rar, p-<=r•, s i>-snnr�0 ire_1,,-VA r°q°r� r+r-si ir1 rr.a_,. ry.n^r v .....iw_.!a :.a:i i era r 1t 1 <br /> ® lYL/1 {'�F,rs'vA RJC.,P6/a? f9 8 R'r,mS..fL.4d.d tiigil Y-t,.1i../r k ) W i �ge,� coy � 1 ,._....,....ei._.,.._.._�,.T.� ............. <br /> w <br /> 14,Special handling Instructions and Additional Information f <br /> tJNa`Y6.S t`,tEECYGLIffl.PROJE�Cr RAILCAR NO. <br /> 15. GENERATOR'SIOFFEROR'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 labeiedlocarded,and are in all respects In proper condition for transport according to applicable international and national governmental regulations.If export sNpmant and I am the Primary <br /> Exporter,I certify[hat the contents of this consignment conform to the terms of the attached EPAAckwMedgment of Consent, <br /> I cert fy that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a targe quantity generator)or(b)QW am a small quantity generator)is true. <br /> Generatorsi eror`s rinte yped Name signature th Day Year ,. <br /> - o <br /> t _j 16.International Shipments <br /> I:__ ❑import tc U,S. ❑Export from U.S, Port of entrylextt. <br /> Transporter s'nature for exports only): Date leavi U,81"- i1:i: . <br /> 17.Transpoder Ackrw;vv�--dgment of Race ipt of Materials -signtu ' <br /> Transporter Pdrda yped Name are _,. " on ay oar <br /> Z Transporter 2 PdntedtTyped Name Signature Month Day Year ; <br /> tY <br /> t-- <br /> 16.Discrepancy <br /> 168.Discrepancy Ind cat on Space ElQuantity ❑Type F]Residue ❑Partial ReeCion ❑Full Rejection <br /> Manifest Reference Number: <br /> 16b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Fadi 's Phone: <br /> t6c.Signature of Altemate Facility for Generator) Meath Day Year <br /> 4 <br /> 19,Hazardous Waste Report Managamant Method Codes(La,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1. 2. 3, 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted In Item 16a <br /> PrintedtTyped Name .. Signature r ^° th Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. 1 DESIGNATED FACILkTY.lO GfNRATQR <br /> f <br /> t <br />