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Please priist or typa.(Farm designed for use on elite(12-piich)typewriter.) Form Approv-J],OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manlfost Traci winbor <br /> "* i`:) i r1i f1 v TE MANIFEST 0 17 1 9 1 2 3 9 JJ K <br /> ' " h 4�a r=. i R.f it11 Q')l.a:;0i; <br /> 5 Gmewluf's Name and Malling Address flenaratoes Site Address(if different than mailing address) <br /> FI F�ESTONL#3566:12 <br /> 940 N.CEN'fRALA'Vr' „':' <br /> FRAC Y CA9C+37(-3 <br /> Generator's Phone: ng'^ry -r 9 r <br /> 8.Transfxrt(of 1 Parnptefy:. U.S.ERA ID Number <br /> I`,S6URY!=NVIRGNP4ENTAi.SERVICES C rl D 0 t>;' r 7 0 a <br /> 7.Transporter 2 Company Name US,EPA ID NMUW <br /> VVORLDVVIDC REGOVF..RY SYSTEM INC- t:A a n n n 1 7 r, <br /> 8.Designated Facility Name and Site Address U.S,EPA ID Number <br /> YLI(vIA YES LLG <br /> 2730 E 1371;ST <br /> YUAr1,A AZ 3536i`, A Z R()0 C)5 1 i G 2 '1 <br /> Facility's Phone: <br /> 9a• 9b.U.S.I]OT Dasddption(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Confalnera 11,Total 12.Unit <br /> 13.Waste Codes <br /> HNI and Packing Group(if any)) No Type Quantity Wt Nol, <br /> 1. <br /> N10N-RCRA HAZADC)US VVASTE, OLID(N0IV-00IdF0RMJNG FILTERS) 7 <br /> I.L. 4,.... <br /> D NI <br /> Z 2. <br /> W <br /> CD <br /> 4. <br /> '4,Spedal Handing Inslnrcilons and AddlionaI Informafon r 7 x <br /> ENil c_t GENICY COIffACT:CHEPA f R E C w 9r)0-424•:aa 30G'a•V0ES TFflN4INAL, CFR E S CS '=,PPROPFii)'E I EIR�S0i`IAL YF;01 E'CI I <br /> EQUIPN'Ief�J ' EPAEFfGF_ C 1NTACl- £:HEN/11 R"EC 800=i_'./4 9`00 TRUCK�It '7—X) _._ PEtCiF,LE•r; 1i3-1-'3(UFISrIR66`, <br /> lli. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of(his constgom and accuratelydeseribed etf the proper shipping name,Ware classlfied,packaged, <br /> marked and Iabeledlplacarded,and aro in all respects in proper condition for transport according I pplicahk' rnalionaland nafir ovammenlal regulations.If export shipment and I am the Primary <br /> Exporter,I certlfy that the contents of this consignment conform to the terms of the attached EPA rAnowladgrn r f Consent. <br /> I codify that the waste minimization statement idenilfed in 40 CFR 262.27(a)(if I am a large qu 'ly general or(n •m small quantify generator)is true. <br /> G of'slOffwor's pqdWyped Name re Monlh oily Year <br /> r 1G-Intematicnal>hipments <br /> Import to U,S. Export fro .S, Pori of enlrylexil: <br /> Transporter signature(lor exports only): Dale leaving U,S.: <br /> w 17.TransporterAcknowledgmantofReceipt ofN-1 edals <br /> raisslsnrPdmod ypod ma Sfgnalure ' f , Moiah flay Yea <br /> 93- <br /> QTransporter 2 Pirinled.rr an:e I Si nature Monkh Day Year <br /> r to <br /> P5 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication SpaceF] I � <br /> Quantity �Type ❑Residue I__J Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Monlb Day W ar <br /> d <br /> z , <br /> 19.Hazardous Waste Report Management Method Codas(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. S. 4• <br /> 1 <br /> 20.Designated Facility Owner or Operator:Cortifcatlon of receipt of hazardous malerials covered by the manifest except as need in Item 16a <br /> ri a yped,Name 5 nature Month Day Yoar <br /> to <br /> EPA Form 8700-22(Rev.3.05) Previous editions areobsxllew DESIGNATC'Ll FACILITY TO I-JEESTINAkTION STATE(IF RE001RIED) <br /> A <br /> I <br />