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f <br /> FormApproved.OMB No.2050.9039 <br /> Pieria print or type.(Form designed form on elite(12-2itch)WMritar.) <br /> 1 Ge creta Dr�u�mber 2.Page 1 of 3.Emeryenvy R se Phone 4.ManHesiTrking Number <br /> UNIFORM HAZARDOUS 1�.� [3 ffi7 i rt 4f 2�PT2 <br /> WASTE MANIFEST <br /> 5.Gene oto s Nameand Mail n9 Addr� P ,r,0 uNG Attft momfCdnarataYs Ne cess{'d Aerant than matihrg address} <br /> Rvc 32M <br /> S.EfDarado`Sk <br /> ,Generator's Phone: <br /> 61 Transporter l Company Name 78.EPA ID Number <br /> t}f or,Pack Luws CO t c"I�1'X73 3iC1 <br /> 7,Transporter 2 Company Name U.S.EPAIDNumbar <br /> B:Deslgnatad Fac lily Hama and to Address. U.S.EPA41D Number <br /> C.DC t UTC1111930i 2,11200 <br /> I 111 we 144waiy 123 <br /> r_-a9tCmtaR,UT M29 USA <br /> Facility s Phone: <br />€ ga. 9b:U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 0.Containers 11.Total E- <br /> 3. <br /> 13,Waste Codes <br /> HM and Packing Group(f any)) No, Type Quantity <br /> I . <br /> o Cfi) i��A,fA Z D!�?'s.S vVASM,�0UD i`f 6f i e";T€'NUI <br /> 4. <br /> i <br /> 14.Special Handling Instructions and AddWal�rtorm lilt <br /> t r- sal Y AR Ljj <br /> Matt- .A SM044f RMN <br /> r-r=PrOgOA041 ISOM <br /> f5. GENERATOR'610FFEROR'3'CERTIFICAT(ON: Iherebyysfed VvtthecontentsofthisconsignmentamMlyand&auratelydm*edabo46bythepropershippingname,andaradassilied,padsaged, <br /> marked and tat etediplacarde{f,astd are In all respects in;propencondit an for transport acca0A9 to applkx*kderrmtbnal and national,pvmmental regotaUons.Kexport shipment and i am the Primary <br /> Exporter,d ce"that the contents of this consignment conform to the terms of the attached EPA'Advwwledgment 6f Consent. <br /> I re*that the waste min n4zabon statement identified inr40 CFR 262.27(a)(d1 am a large 9rmn61ygeneretor)or(b)(d I am a'amaltgUantrly genaratd)Is true. <br /> enemator errs dnt yped ame rma re --IV5M----D5y Year <br /> ri 16.International pmenistr--�� <br /> E-' El impart to U.S. tl Export from US. 'Portof entrylaxit <br /> M Transporter signature jkr exports only): Date lean U.S.: <br /> W 17.Transpbd8rfu&nati�i 9M'flt of Ret t of A#ergs <br /> rw- Transporterl nntad/TypadNama ear <br /> y <br /> Trans rtar 2 P 7 <br /> ? 1 ! <br /> »z po dnted(fyped Narita ay ear <br /> 18.Disaepancy <br /> 18a.Discrepancy Indication Space ElQuentifj ❑ EIResidue El Partial Rejaction Ful;Re}acdan <br /> ManifesfRefarente Number: <br /> 18b.Attemate Hcirrty(or Generator) US:EPA1DNumber <br /> V' <br /> Faci5tys Phone: <br /> 18e.S gnatura of AftemataPa"(or Garwator) Month Day Year <br /> LUi <br /> 19:Hazardous Ylaste Report NanagamesiE Mailed Cotles(e,rides fa tt828rdtk13,r�ste 4teatmani,dsposa};a{�1 racyti�ng_syatasrl,$) <br /> U 1. $ .. 2 3 4. <br /> 20,Designated Fat rq Owner or Operator:Ge0attoo of rec�}0l, azardous coVered by the mantfestexrxEitasrvatsii Ilam 188 r <br /> Pdntediiv Hama igneture Month Qay Year <br /> EPA Form 8700.22( fir.3-0) Previous editions are obsolate. ` U DESIGNATED'FACILITY M GENERATOR <br />