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C/✓ <br /> Please print or We:(Form designed for use on glite(12-pitch)typewriter.) Form.Approved.OMB, o.2050.0039 <br /> UNIFORM HAZARDOUS i,gator ID Number 2:Page 1 of 3.Errergaricy Response Phone ' 4.Manifest-Ibmwn-,Mftw <br /> '5965 FLE <br /> WASTE MANIFEST (J( 371? 1 �l t3 �70,10 <br /> 5.Ganerahx's.Nameand IBngAddress Generators ite'Address(dd event than maifi�address) <br /> €1 e filet L <br /> SVC <br /> Y(;UIX . f1 4' r11Mendono <br /> a <br /> MID S,El Dorado St, <br /> € Ktori,CA %2M <br /> Generators Phone: <br /> Transporter 1 ny Name <br /> _. <br /> 7.Trensportar 2 Campany Name _ _..U.S.EPA ID Number <br /> 8.Designated Facikty Name and Address U.&EPA'ID_'Number <br /> ECDC EovironmenWn)r r nn�sm a nna <br /> (i#i Evian Hovtay123 � t,.f Vr39l4J}g,6544 <br /> Fs Ph . 1 Ea%Carbon,UT 84620 USA <br /> 9a 9b.U.S.DOT Desaiption(Including Proper Shipping Name,Hazard Class,ID Number, i0 Containers 11,Total 12.U04 13.Wash Codes <br /> HM and Packing Group(if any)) No T y .p_a.._ <br /> 4uanlity WtNol. <br /> 1 - 61i <br /> O rr a rd_.a UVv ;TltC i, k,It- r. irftiisdj nGI. <br /> a 2. <br /> 3. _ ... <br /> 4. <br /> i <br /> 14,Special Handling Instructions and Additional informallon ` <br /> tiNie RSALSMVICE RECc m w. Irk S 6 x <br /> ECDC Pr~40411 _ <br /> 15. GENERATOMSfOFFEROR'S CEIMFICATION:i hereby declare that the contents of this cosrsignp!are fu8y and as mtey described dhow by*proper Shipp ng wms,and era classified pat.E aged; <br />` marked and laheledlplscardad,and are in all respects in proper condition for hensport according to applicable international and national govemnwMI regulatloos.if export shipment and i am the Primary <br /> Exporter,i cffN that tie contents of this consignment conform to the terms of the attadW EPAAckno VWgment of Consent. <br /> i certify that the wasta mintmhadon statement idenUfM in 40 CFR 262.#(a)(tf l am a large quantity generator)or(b)(K I am a small quantity generator)is true. <br /> GerwraWslOffer ,ots t <br /> y_.- ear <br /> J 18.international Shipments <br /> D import to U.S. ❑Export from U.S. Port of sntrylad: <br /> Transporter signature for exports only):, Date leaving U.S,:. <br /> W <br /> 17.Transporter Ackn%iodgment of Rao*of Materials <br /> i Transporter 1 bignato' ._. <br /> ,.. y- Year <br /> Nt L-A all <br /> 14 1 11 118 <br /> Transporter 2 PdnUWI yped Name lure <br /> 18.Discrepancy <br /> ._._ <br /> 18a:Discrepancy Indication Space Quentity ❑Type ❑Rsskiue ❑Pertlal Rejection L_!Full Rejection <br /> Manifest Reference Number: <br /> 18b,Ahemate Facility(or Generator) U:S;EPA ID Number <br /> U <br /> FadWsPtona:. ; <br /> w 180.Sgnahrre ofMemate Facility(or Gerwator) <br /> -Month —Day `Year, <br /> C919.Hazardous Waste Ra Man <br /> vy port agerem Mattw Cedes(.e.,codes for imazardocrs mvaste.freahnent,dlspasat,and �'mg systems) <br /> 31 12. 3 <br /> 20.Designated-Faa1' Owner or _ ....r.... <br /> ty Operator Certifcat an of refit of hazarws materials mveredLy the Manifest excwtas rwtad to ttem 18e <br /> Pnntadtfypad Name <br /> Sig re ._,.:.. ._ 'Month Day <'Near" <br /> C 1( <br /> EPA Form 8700-22(Rev.3-05)Previous editions are dbsolete. - -- <br /> _..-_ . <br /> DESlf P!A'fED FAClC1TY T6GEFlERATOR <br />