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rf-I .I P1Y 'i:;`f'!&WL•r'M{ ^ v Ie c Please print or type. °'-� . ' f ,t r { Form Approved, OtAB No, 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2, Page 1 of 3. Erner enc Responso Phone 4: Manifest Tracking NumSK 100 "7039ber WASTE WASTE MANIFES fCALRANK i `°1 t 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Flt ci 1T" ort f1r1tj MVJ; 4tJJ 1F.5, Bevy Dr STOCIP01INl :f rax c3Ks21fzlto)III 117 8 Generator's Phone: 6. 8VG� Transporter1 Compa)ny Name SAp�;; EENI �:'Is1 �i TKta U.S. EPA ID Number E r _ � /� I'vLfL;1r111dL1 ). x'1')r,3 7. Transporter Company Name U.S. EPA ID Number Iii- I N� }'I (1kA (1 { r7 I AdVzfil,7NM 1�11��1 , ( this ,� N it 8. Designated Facility Name and Site Address �i(�NI It1 ) �� Ii�9 c+fIi�1 J`41oE: U.S. EPA ID Number 'B RR' MESA ROAD 1 W410962 Facility's Phone: ' ( F1Vt• y '3yt '.') S X4'.1 gal Ob. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Centelners t1 . Total 12. Unit ' HM and Packing Group (if any)) _ . . . . 13. Waste Codes t'�(1,v( RC 6 +1 CJSL 1t'• ` l t}. rpt 4�Y No,. Type Quantity WI.Nol, . O 1 I'� N r'� CRA I ' it� � fl {��.T4�I: S W�•'Q '�( F 4�0 � DS . .l L'll'. .. yv ••. �:f r.' ' 1,� IMIIIE BP1sJq PETROL, ' UM 14YCY�;L1 ��"� f�BC►t`��i � CD 1AL� A,1*01341;ip 1+iT tEyLtJId Wt 7� IF1rl �la� � x `) I'�` �1z11 � q �� r� �' `r1 It, �.. 3. 4. 14. Special Handling Instructions and Additional Information 4, A �, y , r 1"r.JID d 4.r S 7 �3E 7i t..�� ,,3 tP(I,2654rt r e CE%3� ' H E1�1;~E f � l�!L �' kF3�iX � ��t F1 - 1 ?1J � CN� f �F: f'I'1= ? � f� cill � r �:t k � ? ed r I Yr_ i Ti In ).'Jk7TIfr%fV'k ; t'11" V -f3 *rloferci rule ? lQr +11 Afk 'GIti3Y' I$ ' : y nylt �, y t : v'dfi , b, t ' , _ ' r Y. ri o ,.gyp• i 1 Y1 r3 q to `d rL9F .. 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully andaccurately described above by the proper shipping name, and are classified packaged, marked and labeled/placarded, and are In all respects in proper condition for transport according to applicable international and national governmental regulatlons. 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 minimization statement identified In 40 CFR 202.27(a) (if I am a large quantity general ori cir (b) (if i am a small quantity generator) is true. Generatoes/Offeror's Pfintedrfyped Name Signature !� It�t;tItt- '.tt Month Day Year It 16. International Shipments ❑ Import fo U.S. ❑ Export from U.S: ,y Port of entry/exit Tfansporter signature (for exports only): Dale leaving U.S.: -U •17„.TransporterAcknowledgment of Receipt of Matedals Y Trang$dtoater 1 PrinledrfygedName Signature .= ) _ f sJ ;•. .t,: lf.....".:J. ) V1� l y l �r � Month Day Year n Transporier.2PU edrrypedName ( ` A ' • , fA ''f ) '1 r (. Signature Month Day Year 18 Dsgrepancy 18a. Discrepancy Indication Space ❑ Quantify ❑ Type ❑ Residue' , . _ ' ❑ Partial Rejection ❑ Full Rejection Manliest Reference Number: 18b. Alternate Facility (or Generator) U.S, EPA ID Number i . .- -- -- Facility's Phone: j 18c. Signature of Altornato Facility (or Generator) - Month Day Year 19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) 4 It 20: Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Vern 18a Prinled/Typed Name Signature Month Day Year 4 Form 8700-22 (Rev. 12- 17) Previous editions are obsolete. GENERATOR' S INITIAL COPY