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(lease or _ pP <br /> p type.(Form de12T!l A seen elite(12-pitch)typewriter.) form Approved.Oh18 No.2650 0039 <br /> UNIFORM HAZARDOUS 1,C,eneraloo ID NuAb{ _Pag6_11 3 Emery r�yRE;pgnsa Ptwne 4.ManitastTracking Number <br /> WASTE MANIFEST ftJJ>Lll �lt }} YttiiLL;t R7dd&& ( ` <br /> 5.Generators Name and Mailing nerator's Site Address(it different than malting address) +� <br /> 3200 5 EI Un,mdc). fi. <br /> Generatcu's Phone: . <br /> ranspods,1 pang Nan U.S.EPA ID Number <br /> Nam , <br /> 7.Transpgr#ac2 Garn Name U.S'.EPA1D Number <br /> 8.Designated Facility Name and Site Address {�'�[� U.S.EPA ID Number <br /> c f 1'OTNT10flw i C0930 1204 It <br /> 4 I i I West Highway 123 <br /> T ada•4 i East i ors,UT 6464 USA <br /> Fadiitys Phone: <br /> ga, 9b•U.S.DOT Description(indudiq Proper Shipping Name,Hazard Class,10 Number, 10.Containers it.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WINW. <br /> 1 <br /> N, 14 4ZARDOUS WASTE SOLID(Wn-POT regiAawd) 06`i H13 � <br /> 2. <br /> edl <br /> t9 <br /> 3• <br /> SA. pedal Hard3i'instructwns and Additional Information <br /> n9 <br /> Y PFJEGT fitAt. <br /> �loti��Ct2hh: _ <br /> Et3G 9 is � ` <br /> 15: 'GENERATOR'SIOFF.EROR'S CERTIFICATION:I hereby declare that the contents of nment are,dlyand accurately described above by the proper shipping name,and are dassified,packaged, <br /> marked and fabeledlplacarded,and are in all respect in proper condition for trarispart. Ing to applicable international end national*emmentai regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the cantents of this consignmentmm, <br /> conform to the teof tj „.EPAAcknarAedgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 C1711262.27(aj(if i a rge quantity generator)or(b)(it I am a small quantity generator)is true. <br /> Ganeratoe- elors rinte ame as on ay ear <br /> .a 18.international Shipments �-7� <br /> i- 0 import to U.S. ❑Expo t om . Port c <br /> Transporter signature far exports only): Date I S.: ` <br /> 17.TransporterAckrKm4edgmant of Receipt of Matedais <br /> Transporter 1 Pay <br /> Name <br /> Signature <br /> on ay aar <br /> A <br /> Cr , <br /> DS , <br /> Transporter 2 PrintedtTyped Name bignawre Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej j <br /> ❑Partial Ra eclion ❑FuSI Rejection <br /> Man!fest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> FadWs Phone: . <br /> e� 1 Siomwre of Wtematp Fac Gty'{a Cenefafor).' Month Day Year; <br /> iS NazamloU�4lysi Report ManagatnenkMethodCades(i.e boirx,hersrdatiswastefraatment drsposafpndrecyding.systams) <br /> o f J 2. 3 Q , <br /> 20.Designated Facility Owner or Operates:Catfification of receg4 of hazardous materials.aovered by the ri>ffiu7est except as now in item lea ` <br /> PnntedTypad Name Skirv?ture Month <br /> ! � ZY-1 <br /> U <br /> EPA Form 8700.22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />