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'lease print or We. (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 MANIFESTr (}rtS SGS is= . h i i �.� l0ii 01 03732248 GBF <br /> 5. Generator's Name and Mailing Address Generttoes Site Address (ifdifferent than mailing address) <br /> AVOERICAIvI RECYCLING <br /> �1`ut� t4i t:3itl . Grt H��C1zi <br /> Generators Phori& i <br /> 6. Transporter t Company Name U.S. EPA Ip Number <br /> iI3cliti. CiD<T2aQ� <br /> 7. Transporter 2 CompanyName U.S. EPA ID Number <br /> ,c setq ? qy EiJVIRUNNIEIN IAi '- `E A"fI4.:ES C GlCt2S212?02 <br /> B. Designated Facility Narfie and Site Address U.S. EPA ID Number <br /> tit OL <br /> TF3G tr. "i 3"F f t 5T AZR€t00175 '.22 <br /> Y U4V4A� AZ g.n30J <br /> Faclity`sPtutne2i�� <br /> ga. 9b. U.S. DQTDes* inn (including Proper Shipping Name Hazard Class, ID Number, 10. Containers i1 . Total 12 Unit 13, Waste Codes <br /> HM and Packing Group tgany)) No. Type Quantity w Nos. <br /> a0 t\tf7ly- 4 Alf ?FSS t�1C9£i. tlt; i i' S(�t.tt7 A#��:t7RRF_i�tt i f1tFtf :i f ]iu{ tti P 352 <br /> 11 <br /> ss <br /> Ul ! <br /> 1 <br /> 3. <br /> 4. <br /> 14.Speaal Rafidlihg tnstnrcfmns andAdditiorrattrrfonnation <br /> PROFILkA 1811174NR$ !:550RBEN'T. DIRT, 000LANT ERfW T1 <br /> EMEPGENC Y CONTACT!, JEEREM'f <br /> 15. GENERATOWStOFFEROft'3 GERTfFICAfION; Iherebydeclare thatlhe contents of this consignment are fully and aoomtely deson'tied above by the proper shipping name, and are classified, packaged, <br /> maked and tabetedlplacarded, and are 16+911 respects in proper oonOon for transport aowreing to applicable International and national governmental regutations:.lf export shipment and I am the Primary <br /> Exporter, i certify that the contents of this consignment confoan to thele rms of the attached EPAAdmovrtedgment of Consent. <br /> I certify that the waste minig tzation statement Identtiled in 40 CFR 262�7(a) (91 am a large quantity generator) or (ti) (NJ am a small quantitygenerafor} is true; <br /> Generator / tferoesPdatedirry* Name Signature Month Day Year <br /> V tea <br /> �- <br /> .1 96, International Shipments El Import to U;S. � Export from U.S. Port of eniryexh: <br /> . Transporter signature (forexportS'pnly}; Date leaving U36: <br /> 17. ,Tra rAdpodgment of Receipt of <br /> f- FransPwEer _ Vature — '> <br /> j . ...1 <br /> 3)09portsrn lig <br /> hronth my jVY&rq, <br /> 10 <br /> 18.Oiscre � <br /> 18a. Discrepancy Indication Space ❑ Quantity FIType <br /> ❑ Residue Partial Resection ❑ Fidt Rejection <br /> Manifest Reference Number. <br /> 18b. Alternate Facility (or Genaraior) U.S. EPA ID Number <br /> ural Facitity9 phone; <br /> 48C =Sl9tiatuiaofAltetiateFadlitp {orGeiteiator} Month Day Year <br /> 104 Hezardous WasteRepor(Managemerrt Mekod:Cades (.e., cddesforhazardow wiaste treatment, drsposat, and recycling systems} <br /> 9'. 2 3. 4. <br /> 20, Designated Facility0wneror Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in tiem 18a <br /> rintetlrfy Name Signature Month Day Year <br /> EPA Farm 8700"22 (Rev. 3-05} Pravioua editions are obsolete. <br /> n1".q1P.WATFn FACILnyTo [)ES 11NATION STATE IIF tREQUIREDIt <br />