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J�AK H14s q , 7y Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved, OMB No, 2050-0039 UNIFORM HAZARDOUS 1. GenemlorlD Number 2. Pagelof 3, Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST 5 3 -aq 8' I 018 0 4 7 2 6 7 JJ 5. Genemlors Name and M�alllPy9ddfees Generators SlleAddress (if difierentthan malting address) ARAmna.K (fw/t02M SAID CAW-AZ2- 4PpAUZ, LLC 7679 ZOOV3G �5 STicKiay✓ C Generators Phone 6. Transporter 1 Company Name U.S. EPA ID Number �i4P c✓esT n.�n77vr�L sca ✓yc � s &Ot)0J VT4r 7. Transporter 2 Company Name U.S. EPA 10 Number 8. Designated Facility Name and Site Address .*. /N U.S. EPA ID Number 35d S{ oZb skovlwA16 A �/p'►�Cn+nn✓ 4r,&Ty CA q 3 a3q Facility's Phone: ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 , Total 12. Unit HM and Packing Group (if any)) Quantity Wt.Nel. 13. Waste Codes No. Type 0 ' "Al AAAA 1`1h21WOOS WA51EI 60L` D 01 Y � Z 2. 3. 41 14y.�SS,,p� l eeciaHandling Instructions and Additional Information 0 - 40 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately 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 regulations. If export shipment and I am the Primary Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I cedlty that the waste minimization statement Identified In 40 CFR 26227(a) (If I am a large quantity generator) or (b) (if I am a small quantity generator) Is tris. Generatar's/Offeg.'s gt(nted/Typed Slgmturo Montthh - Day Year —+ 16. International Shipments - F- ❑ Import to U.S. ElExport from US, Port of entry/exlt: z Transporter signature (for exports only): Date leaving U.S.: 04 17. TransporterAcknowledgment of Receipt of Materials K Transporter 1 PdntedlTyped Name Signature Month Day Year Transporter2 PrIntedtlyped Name - nature Month Day Year 18, Discrepancy 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residuej El Full Rejection ❑ Partial Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U raa. Facility's Phone: 18c. Signature of Alternate Facliity (or Generator) Month Day Year Q z N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal; and recycling systems) 0 1. 2. 3. 4. 20. Designated Facility Owner or Operator. Codification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Proded/Ty ed Name Signature Month ' Da Year - e, vtrk�� -� 0912 , 1 IV EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESSTINATION STATE (IF REQUIRED)