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Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A t- i 7 7 r. iL2001424.93fNi JJ K <br /> 5.Generator's Name and Mailing Address <br /> MAT PACIFIC LLtI Generators Site Address In differentthan mailing address) <br /> iON <br /> IR DR <br /> CA 45376 <br /> Generator's Phone: "`'3 363-9799 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> �NMENTAL SERVICES <br /> 7.Trenspar iiERYSY?rTEMINfi. <br /> oner 2 Company Name U.S.EPA ID Number <br /> } � <br /> : <br /> 6.Designated Facility Name and Site Address FiCrp017 <br /> Yo'> wICNT,INC. LLS.EPA ID Number <br /> 65';G Id-GHWAY98 <br /> YUIviA AZ 85365 <br /> Facility's Phone: 81944. A]-R O O 0 S 21 14 6 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) . Type Quantlty Wt.it.Total 12.Unit 13 .Waste Codes <br /> No <br /> oc NON-RCRA HAZARDOUS WASTE.SOLID(OILY'SOLIii <br /> 0 352 <br /> P <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT!CHEMTREC 1-QOU•424,9300 WOES TERMINAI.'CERE.9 CS HAER60 981 : 171 *PROFILE 0/991: <br /> 162623NRSCEM637RAGS/KITTY UTTER * *APPROPPV,.' '."'i-; ,;t,;, nnENT ��'''✓✓ <br /> 15. GENERATOWSIOFFEROR'S CERTIFICATION: Iherebydedam that the contents of thisconsignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulators.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment cordons to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(t I am a large quantity generator)or(b)(AI am a small quantity generator)is true. <br /> Generator'sl0lteroes Printed/Typed Name Signature Month Day Year <br /> `✓ 16.International Shipments <br /> LJ import to U.S. ❑Export from U.S. Port ofenVy/exit: <br /> Transporter Signature(for exports only): Date leaving U.S.: <br /> W 17.TmnsPDMfAdmowledgmenlofRe iptofMatedals <br /> O Transporter 1 Printed/Typed Name <br /> Signature Month Day Year <br /> a <br /> q <br /> G Transporter Printetl(Typed Name' Signature <br /> � Month Day Year <br /> F <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type EJ Residue El Partial Rejection ❑Full Rejection <br /> 18b.Alternate Facility for Generator) Manifest Reference Number. <br /> .-r U.S.EPA ID Number <br /> U <br /> u Facility's Phone: <br /> Ow 18c.Signature of mm ate Faciiitytor Generator) Month Day Year <br /> Q <br /> 2 <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. 4. <br /> 20.Designated Facility Omer or Operator:Certification of recaipt of hazardous materials covered by the manliest except as ruled in Item 18a <br /> Pantedrfyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> GENERATOR'S INITIAL COPY <br />