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3540 East Carpenter Road PR0542634 <br /> February 14, 2020 Program: HW <br /> PHOTO 4: Manifest 020022994JJK found without a desi nated facility signed off copy. <br /> Please print or <br /> pill <br /> UNIFORM HAS <br /> �'1STE Form Approved.OMB No.2080-0039 <br /> M0. 1/111101 -7Ne-ncy Res To Phone d.Manlh iTrllcxlnp Numlur <br /> 5 Gener ==�63ssa536 O1�020022994 JJ K <br /> Ganere[ors Site Address(if different Nen mu7,—;ddress) <br /> Generator's ph. - <br /> raI— <br /> nspoderll 1 <br /> CLEANTEChI ENVIR(*&gEN7"At- U.S.EPA ID Numlxr <br /> .. 1 CM_0003098M <br /> 7,Tnmsporier 2(omany Ne ire Ip <br /> U.S EPA t0 Number <br /> e.Deagnated Fannry rvame and sire Addmss MER STAGE EIIVIRObIENTAl BERVICI=S Li.0 I U.G.EPAIDNumbar <br /> 28i,EAST 6110REY FIORD AZO061TO5402 <br /> ,GOLIDGE,AZ 86128USA <br /> FaNrty's Phone:'520-723-167 <br /> 99. 9b.US.D17T Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Totat 12.Unit <br /> HM and Packing Group is any)) No Tsps Cuantity Wt.Not 13.Wast,Codes <br /> X 'i RO,ItN WPW V _Wft AEROSOLS FLM1ugIB1.E,n o.ls.,2.1(PtlUIYT OM P � 331 <br /> 0 LUSIRICANTS)r(00016ER0#J28 <br /> IQ—Q <br /> lu 1 <br /> :C 2. <br /> Lu <br /> [7 <br /> 3. <br /> d. <br /> 14.SpeciaHaMling InsWctions aad Additional Infomrab., <br /> POI(AER WLS)'tf _USE GLOVESAMOOOGLES TIRUCKN <br /> (AEROSOL:Sry _ — <br /> CALLER MUST IDENTIFY CLEAF(TE.'CH ENVIROWEMAL A8 REOISTRAMT:NVFO TRAC 8100-+5356053 <br /> 15. GENERATOR'S101°FEROR'S CERTIFICATION:I hereby declare Nat the contents of—,iswnsignment are fully and accurately described above by Ne proper shipping name,am are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper contlition for transport according to applicable intemationalan0 national governmental regulatigls.If export shipment and am the Primary <br /> Exporter,f cemfy that the contents of this consignment conform to the terns of he attached EPAAcknZWgment of Consent. <br /> I certify hat the waste minimization statement identified in 40 CFR 28227(1)(if I am a large quantity generator)or(b)Off am a small quantity generator)is We. <br /> Genemtof OBerors Pan Name :signature Month Day ` <br /> ',,a: _l am <br /> -1 18.Intemaaonal Shipments <br /> H 'J Import to U.S. ❑Export from U.S. Port of entryl nat: <br /> ? Transporter s1mature(for minions only): <br /> Dat.leaving U.S.: <br /> W 17.Transpomer,! naxledgmenl of Rgx'ipt of Materials <br /> Transporter 1 Printed/TyWi Name <br /> n Signature - Month Day <br /> i TrampW,2Pnnfed/Typed Name <br /> Signature Montle Day <br /> 18.Discrepancy <br /> f8a.Discrepancy Indication Space <br /> Quantity ❑Type ❑Residue ❑Penial 'gctgp D,FuII R.I. <br /> f �� Manifest Relerence Number. Y <br /> U.S. <br /> Facd <br /> f F <br /> sfor hazardou —+- <br /> 3. <br /> _y1 <br /> Pature� kth D <br /> Lydia Baker, REHS Page 4 of 8 <br />