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J <br /> P print or type,(Form designed:for use an elite(12-pitch)typewriter.) Farm Approved.OM®No.2050-0039 <br /> 1.Generstor ID Number 2.Page 1 of 3.Emergency Res�on>re f>tmona 4.Nia05IFRMFLE <br /> :UNIFORM HAZARDOUS v'l�L4iE3C1. 67)7 t 415-bf1�"-P <br /> WASTE MANIFEST <br /> 5.Generators Name7nd Malting Adr'j% 9VC RECY i tC- R- €1ttf81R MeftdofloRGenerator's icor Address(If d'event than maA ng address) <br /> 3A S.El Wrado 5r. <br /> a16"llon,Oft OM <br /> Generator's Phone; <br /> Transporter6. Company ama U.S.EPA ID Number <br /> uNor;P --$ids trt r`s{ 1 Aa re ori btaiu <br /> 7.Transporter 2 Company Name U,S.­EPAID <br /> 8.0esk noted Faality Name and SiteAddress US.EPA 10 Number <br /> Crit t18Er f I UTC663301220i, <br /> 1 I I i V e wn Rgtiaay 12D <br /> East C.arbt f1,UT 94626 USA <br /> "Facility's Ptmaene 1 <br /> 9a. 91b.US.DOT Description(including Proper Shipping Name,Hazard Class.ID Nurnber. 10.Containers 11,Total 12,Unit 13,Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity WLIVoI. <br /> 1. i l&i1 <br /> O <br /> ' NQ,a=R -'RAWRDANS'WAST , re guLvkd1 `�;l Y►� A <br /> 2 <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> !1.i mlfs , 4141 16 U05 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of ihls consignment are fuliyand accurately described above by the proper shipping name,and are elassllied,packaged, <br /> marked and labelediptaearded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am tne`Pr maty <br /> Exporter,l certify that the contents of this consignment conform to the terms of the attachod EPAAcknowledgment of Consent. <br /> I certify thatthe waste minimizat on statement identified 1,40 CFR 26227(a)(d;1 am a large quantity generator)or(b)(ff I am a small quantity generator)is true. <br /> Genem s ame nor re ay ear <br /> 57-1-1-fA) <br /> 16.Intemational Shipments <br /> ❑import to U.S, ❑Export from U.S. Pori of entry(axlb <br /> TransR LhIar s nature Lor export only): Date W2.g U.S.: <br /> a 17.TrampoherArdum MedgmentofReceipt of,M3W s <br /> ar <br /> Transporter 1 nn yped Name <br /> LL fi <br /> r a <br /> 2 Transporter 2 Pdntedlfyped Name gnature Month Day ear <br /> 18.Discrepancy ff��-11 f(�--11 rr--11 <br /> 18a,Discrepancy Indication.Space ❑ Quantity IJ Type LJ Residue LJ Partial Rejection ❑Ftd€Rejection <br /> Manifest Reference Number. <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> .:a <br /> u< Facilitys Phone: <br /> L—U 18c.Signature of Ahemate Facififty(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes Cho„codes for hazardous waste treatment,disposal,and recycling systems) <br /> i2o,1. � 2.Designated adlttyOwner or Operator.Certification of rec*of hazardous materials covered by the manifest exrepi as noted In Item 18a <br /> rin—L-0ypad Nara Signature Month Day Year <br /> 1. �I i— <br /> EPA Form 8700-22(Rev.3-05) Previous eiHtioris are obsolete. ESIGRIATED FACILITY TO GENERATOR <br />