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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 d.Manifest Trackln Number <br /> WASTE MANIFEST 6m.41L WL331567`i7 q 495-823-8772 r L <br /> 5,Generator's Name and Mailing Address; - <br /> erators Site Address(d different than mailing address) <br /> tr !ER3.41-SIT RECY :.iNG Asn 7tEftanl` n or <br /> 320U S,El Dorado St. <br /> �tr€ekton,�� <br /> Ganarator'sPtionei <br /> rensporlor T Company ame. D Number <br /> U.5 EPA I <br /> 7. <br /> Transporter 2U S <br /> Cqi ony Na ti, EPA tD Numher .. <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> EF. C ( LITU19301220i <br /> 1919 West Howay A 23 <br /> 4- East Gwbon,UT 84620 USA <br /> Facitit}es Phone: <br /> ga 9b.U.S.DOT Dasuiption(including Proper Shipping New.,_Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13,Waste Cases <br /> HM and Packing Group Ill any)) No. Type Quantity Wt vol. <br /> 1'c�Xr�-:;�A-kZeDOR' r�t®vr€ "�,�� �tu_ -00'1a_uBeu} �G® <br /> d. <br /> E <br /> d. <br />: <br /> 14:Special Handti Instrcctiq!Is andAdd i eral Information, <br /> n9 <br /> ECD <br /> c Pr 4041 <br /> 15. GENERATQR'StOFFERWS CERTIFICATION<i hereby declare dial#4a ontsnts 61 this i ns3grimaiit are fully end a rratsiy dasciibad abova bV the proper shipping name,and are classified'packagers, <br /> mord ed and labeled/placarded,and are fn all respects in properwrdtion for transport secording to eofcatkrt internafartal and national govemmental regulations.If export shipment and lam the Pdmary <br /> Exporter,I car*that the contents of this consignment w*n to the tans of the attached EPAAcknoveledgment of Consent. <br /> I certify that the waste minimizaton statement identified In 40 GFR 262.27(a)(if I am a large quantity generator)or(b)(If i qq a smap,quantlty generator)Is true. <br /> Generatoes[Offerars Pri y ameigna re on ay ear <br /> Vl <br /> —r 16.International Shipments ❑Import to U.S. ❑Export ham U.S. Pod of enhylerdt <br /> Transporter signature for exports onl : Date leaving U.S.: <br /> 17.TransporterAckwwtedgment of Receipt of Materials <br /> Transporter 1 Pnnledffyped Name gnature Month Day Year <br /> a <br /> -4114 <br /> Transporter 2 Prinfetlffyped Name signature Monlih Vey Year <br /> t- <br /> 16,Discrepancy I�1 <br /> 18a.Dis-crepancy Indication Space F-1QuantiQuantity El J Type kesidua ❑Pan1a1 Rejao6on ❑Full Rejection <br /> Mariffest Reference Number. <br /> 16b.Atamate Facility(or Generator) U.S.EPA ID Number <br /> Ute- Fadtis Phone: " + <br /> 1 ic;S gnature ofA timate Facility(or Genaretw} -Month,.",Day,' Year. <br /> k <br /> � �i9.F{arardoirs V3asta Reporthlenagamehiti66etttod Cofe�(te fa.hazardaa'va�traatrieM,�isposa1;arld ror.5�9;�thrP?)..:. :,: � � :: <br /> y- 20.Des gnatel Facility t}anar or Opsrafa Ceittfit <br /> tion' raw pi of frazatdaus'matenals wvered by the msest except as,now n Kam•18a <br /> Printedfi'ypedName r^ i Month Day Yeer <br /> ® 1 <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />