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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,4M6 No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Ge0era{oruf�f�� 717 2.P1age1'of °�EmeZggr�ggs�gnsePhone 4.ManifestTrackin Number <br /> WASTE MANIFEST LL f]4 11``SSti� f#lttdddd <br /> 5.Generator's Name and Mailing Ad ; neratcrs Site Address(if different than mailing address) <br /> f"aa'Ai. c RECYGUNG AlffwNlaffl'!>kendsfto <br /> KGO Ljorado St. <br /> Generainrs Phone:. 0. <br /> ranspodar 1,t rnpany amre'.. USEPA ID Number <br /> 7.Transp6'rter2 Ccrnpany,Namo U•S:EPA 10 Number, <br /> 8.Res gnafed Fac lity Name and Site Address U.S.EPA ID Number <br /> FGr—t I t7YStOYtt71 ) <br /> 11 I i *rlt t# 123 iii <br /> FadlWa Phone: <br /> -444-4461 Fast Garball IJI" 4355M USA <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11,Total 12.Unit <br /> Hk1 and Paradog Grasp(U any)) No. Type Quantity WIN01, 13.Waste Codes <br /> z 2, <br /> 8 <br /> 4 <br /> 14:Spedal Handung instnnctionsand Additonai information <br /> tJi FtSALe ftCY'CL P, . R. <br /> N06-RCRA Muedder Residue <br /> ecDG 1 1 ,.. . , <br /> 15. GENERAT0R'S10FFER0R'8 CERTIFICATION;-I hereby declare that the catdants of this oonsignmant are fully and accurately described above by the proper shipping name,and are classified packaged, <br /> marked and Iabeladlplacarded;and are in ak respe s In proper condition for transport according to applicable intamallonal and national governmental regulations,if export shipment and I am Ura pdmery <br /> Exporter,I certify that the contents of this consignment conform to ft terms of the attached EPAAcknowledgment of Consent <br /> I certify that Ura waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)fjI am a small quantity generator)is We, <br /> enara s1 ero(s dnt yped Name na ra ay ear <br /> ri 16.Intemalional Shipments tI--1i i <br /> LJ Import to U.S. ❑Export from U.s. Port of entrylexit <br /> ir� Transporter signature for exports only): Date leavinq U.S.: <br /> 17 Franspor* :w r <br /> ul <br /> ,. - t <br /> a#: { <br /> Transporter 'PdntadlTyped Name gnatura -Md,nff ay' ear <br /> z Transporter 2 PdntedJTyped Nameignature y Year <br /> 18,Discrepancy <br /> 18a.R saepency Indication Space ❑ Quantity ❑Type 0,Residue Partial Re}ection Q Full Rejeeti xn <br /> Manifest Reference Number: <br /> 18b:Altsmate Facility I&Generator) <br /> U.S,EPA ID Number _ <br /> u Fagk?s Ptwae:. <br /> 18d S�os[uraofAttenateFadtdy{oi.Ganarafar) Month Day .Year <br />'I <br /> '' 19.Hazardous Wash Re <br /> pdif,�anagamentfhathgdCpdaa{is;, #prhazaniauswastefraatment,`dra�aPandrecycl�gsysiems):, ,......, � ; <br /> 20.MergnatsJ Facility Owner or Operator:Ceftatkm of receipt of hezardous materials covered by the manifest except as noted in Item i8a , <br /> Pdnted,Typad ame igna,lu. <br /> Month Ray T <br /> FPA Form 8700-22(Rev.3 05) Previous editlons are gbsolete. DESIGNATE©FACII ITY.TO GENERATOR <br />