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Please print or type.{Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page I of 3.Emergency Response Phone 4.Manifest Tracking Number I WASTE MANIFEST '� r ,� s� JJ K- 5.Generator's Name and Mailing Address Generator's Site Address(it different than mailing address) Generators Phone: 6.Transpolar 1 Company Name U S.EPA€D Number 7.Transporter 2 Company Name U.S.EPA ID Number 41 �5 422 8.Designated Facility Name and Site Address U.S.EPA ID Number I-rvices, Inc. 730 past i:n' Street Yana. Arizona 86365 Facility's Phone: 928-642-8938 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 0.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. i. jN—R(;RA HAZARDOUS SOLIDS w i w 2. C7 3. 4. t 14.Specia€Handling Instructions and Additional Information 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledfplacarded,and are in all respects in proper cond!Wri for transport according to applicable international and national governmental regulations.If export shipment and-I am the Primary Exporter,I certify that the contents of this consignment conform to The terms of the attached EPA Acknowledgment of Consent. I certify that the waste mmimizatien statement identified in 40 CFR 2bZ27(a)(61 am a large quantity generator)or(b)(i!I am a small quantity generator)is true. Generator's>'OfferoesPrinted'Typ' Nome Signature � r Month Day Yea[ —1 116.International Shipmentsrt F ElImport to U.S. ❑Export from U.S. Port of entry?exit: K Transporter signature(for exports onl Y$ Date leaving U.S.: LW 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature r Month Day Year Q Transporter 2 Printed Typed Name r�patun Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ f ❑Full Rejection ❑ Quantity Type Residue Partial Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ LIE Facility's Phone: 3 18c.Signature of Alternate.Facility(or Generator} Month Day Year a z N19.Hazardcus Waste Report Flanagement Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 B PrintedlTyped Name = Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FA=l]TY TO GENERATOR