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tl <br /> ,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 CAFA0012$791 1 g&6-sy9-47� 00152a�843 FL <br /> E- <br /> 5.Generatces Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> LuxoWrs Rti Wl LEN RS#135 <br /> 4WO Luxafta;t PI do.lay Bawling 490 PArAFIC AVENUE <br /> Genera s PhttV 450404114 ST CW'CA 06207 <br /> 10"27=A I 1A <br /> 6.Transposer 1 Company Name U.S.EPA ID Number <br /> AIAREX ENVIRMNIEWAL scLu oNs 0XIM7222179 <br /> 7.Transporter 2 Com ny Name U.S.EPA ID Number <br /> M.crCK ®Y .27a ILY <br /> 8.Designated Facility Name and Site Address U.S,EPA ID Number <br /> WASTE owwas INC. <br /> STA UM DRIVE X1123391 <br /> KANSAS CITY,PAID 64129 . <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers '11.Total. 12.Unit 13 Waste Codes <br /> HM and Packing Group(if arry)) No. Type Quantity Wtivol. <br /> "Waste Flammable solfis,ol'Ranic,nos. (bopropy9 352 D001 <br /> X <br /> AICOW. con ' ,4.1 , UN132S,9 RQ DF P <br /> z 2: <br /> W <br /> 3.. <br /> 4.. <br /> 14.Special Handling Instructions and Additional Information <br /> 1.)Appoval AES-384M:ER43 0138 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described ahove by the proper shipping name,and are classified,packaged, . <br /> marked and labeled/placarded,and are in all respects in proper condition for transport arxording to applicable international and national ntai regulations.If export shipment and I ani hi Primlai <br /> Exporter,I certify that the contents of this consignment conform to the terms'of the attached EPAAckno-Medgmen!AConsect. >1 ; <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity genera or(b)(if I am a all qua rator) <br /> en <br /> s/70UPrintedfT_ypadNaing,,,,,� are Month Day Veiir <br /> .i 16.International Shipments <br /> Z ❑Import to U.S. . ❑Export from U.S. Vate <br /> entryfexiC <br /> Transporter signature for exports on ti U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> a <br /> Transporter.L99tedlTyped NamSignature Month Day <br /> Year <br /> O �W i <br /> 73 <br /> Z Transporter 2 Primeyped Name / Signature on ay Year <br /> t�sZ_ JA�c1 r 1 ®� <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space 0 Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection. <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J ' <br /> v <br /> Facili s Phone: <br /> LL, I k Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> J2. 4. <br /> Ll20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> "edName Affnaturel Y r =�S <br /> EPA Form 8700-1V2(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br /> I 10463.1129 <br />