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4se,print or type:{Farm designed for use on elite(12•pitcfi)(ypewriter:) form Approved,OMB No.2050-0039 <br /> _ 1.Ganerstor M Number 2:Page 1 of', 3.Em �espouse Pion 4.h1 ng u <br /> UNIFORM HAZARDOUS _ 1 4 i MINIM" <br /> WASTE MANIFEST ? �3 '1 i L <br /> 'S, neralor'a Nara and Mailing Address Generators Site Address(d different than mailing address) <br /> 1"�FW>AL 9VC RECYCILING A,jrr VMaM MQMGROB <br /> 3200 S, !1)cg du St. <br /> wtCstYttt1,Cha <br /> Generator's Phone: <br /> Transporter6. 1 Company Name U.S,EPA ID Number <br /> Union Pecft Gins 00 <br /> 7:Transporter 2 Company Name U.S.EPA ID Number <br /> 8:Dei5natad Facility Nameand iteAddress U.S.EPA iD Number <br /> E{_DC EnvironmenW UP-1093011 A i <br /> i 11 i West HWWvzq 1123 <br /> amt as � East Carbon,UT 84620 LISA <br /> l Faditys Phone: <br /> ga. 9b.U.S.DOT Dosaiption(Including Proper Shipping Name,Hazard Class,ID Number, 14.contakrars 11.Tonal 12.Unit 13.Waste Codas <br /> HM and Packing Group(d any)) No. Type Quantity WtNcl. <br /> V -a'Y_aoti VAS ,SOLD R _r <br /> -LTi€"E' g {30Y 611 <br /> " st <br /> E 2. .. <br /> ra <br /> 3, <br /> 4 <br /> 14.SpeciaiNandring in h6ons arrdnd Additai lnforrnatio6 —� <br /> 19. GENERATOWMFFER. 'S CERTfFICATION: [her decEsre filet the 004114 Ms of this cori'slgrxioetit ere filly and accurately described above proper shipping name,and are classl W,packaged, <br /> marked and lahe;ar 0carded,and are in al respect in proper condition for transport accorda�g.ln appBaaWe irttematiatai and net Dual gbtum raguEetiass:If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EMAOx,01ledgmamt of Consent <br /> 1 ce"that the waste minimization statement identified In 40 CFR 262.27(a)(if I am s largapuantlty gerarator)or(b)(d i arria small quantity nara6sr)is bua. <br /> ne erues do WeNam nor n' Y ear <br /> . 18:intematonal Shipments <br /> p ❑Import to U.S. ❑Export from U.S. Port of eiveytaxit: <br /> Transporter s"naWre for exports orri . <br /> Date learn U.S.: <br /> w 17.TrarrspwtarAckumwledgment of Receipt of Materials <br /> ransporier 1 .i n yPed <br /> ear <br /> Z Tmnsporter 2 PnnUx Typed Nam 51naturs Year, <br /> y� r <br /> 18.Discrepancy <br /> 18a.Discrepancy indicat on Space Quantity ❑Type 1' <br /> J Resbtw ❑Parti RejeedSon ❑Ful!Rejection <br /> Mardfest 0afemics Number: <br /> 78E-,hamate Facility(ar Genoretor) U.S.EPA ID Number <br /> U <br /> U Facili s Phone: <br /> U0 '18c,Signature of AfteirialsFadlity(or Generator) Month Day Year <br /> 19.Hazajdous Waste Report Management Method Codes(i.e.,codas for hazardous waste treatment,disposal,and recycling systems) <br /> 1, 2. 3. 14. <br /> 20,Designated Faclityy Owner or Operator.Certification of reoW of hazardous materials covered byte manifest except as noted in dein 18a <br /> dntaVyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. MIGNATEDFACILMYMMERATOR <br />