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Please print or type.(Form designed for use on elite(12-pilch)type%vriter.) (A,42.-ft i� � ' Form Approved.OMB No.2059.0039 <br /> ffcnecatoes <br /> ARDOUS 1.Generates ID Number 7.Page—1.f-F3,Emergene)Response Phone 4.Manifestt�Tracking <br /> Number 7 ] } /� <br /> IFEST uAE_C13i7`' (R_i7 r'�.-�F7 0011 [_021 1 1 LJAT <br /> me and fLai'�ingAddress Generators SiteAddress(d Merest than mai'ing address) <br /> MG )_eTs �:I,T.IP RD AIRI: B "A FER11RU 2ERI k. TRA.. ro wimn f 3' 7E <br /> 6,Tfanspater t Company Name a U.S.EPA ID Number <br /> STFV1CYQ1 ELTY U1 _'TF S01 'UT O;dS TNG 1INSOnn11.L <br /> 7.Transporter 2 Company Name <br /> U,S,EPR ID Number <br /> G` <br /> B.Designated Fac!ity Name and Site Addre U.S.EPA ID Number <br /> MT GENTURY RVIROMNL nRRbEI` AT O!. hEYP!-, LLC <br /> 2095 Rewrlande, Part: East <br /> FudLf 'spho'ne. F ;EY., M M94 f7751 SZE-77EG Z <br /> 9a. gb.U.S,DOT Description(in;3uding Proper Shipping Mama,Hazard Class,ID Number, 10.Containers 11.Total 12.Urit <br /> HM and Parking Group{if any)) No. Type Quantity VILNCI 13,Waste Codes <br /> alf 1 ....1 o tfr1CT ,£ <br /> t 1U 1Z2_) <br /> LLJ� <br /> z' 77� <br /> URIS13 VPSTE FLP?;011E LIMBS-, R.O.S. NFROSLNE, PIEKI) 3 P613 t }— 331 DQU BLTQs <br /> " }C RP(R9FiI=1aa) I( P <br /> 7 <br /> 3' U? IZ, RRSTE TOXIC, LIQUIDS, GFGRf(TC, 9.0.5. (2r(-P1 6.1 PGR r <br /> 11n10 <br /> X L1 <br /> 14.Special HendIng Inshuctims and Afttional Information <br /> (:: �^Lai qir- i;Fnv��, (21 ILFL(T1.fLIO 3 - MUM MMIRE L IVU136 (3} 1110XIC-0 ERG(153) TOXIC <br /> LIQUIDS LDG EP <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICAT)ON: I hereby declare that the contents of this consignment are fully and aomrateIy described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlpiacarded,arra are in all respects in proper condlion for transport aab ding to applicable international and national govemmental regulatons.If export shipment and I am the Primary <br /> Exporter,I cerbiy that the contents of this consignment cenfom to the terms of 11w attached EPAAanowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFP.262.27(a)(f lam a large quanRy generalor)or(b)(if I am a small quantity e, lot)is we. <br /> Gene tors) urs FrimledyT d Name signalul Month Day -Year. <br /> 'Jur E tol <br /> 16.Intemtatrcnal Shipments <br /> F- 0 Import to U.S. ❑Erpart from U.S. o G I <br /> — Transporter sjrnature(forexports only)' Dale leavi g U.S.: <br /> 17.TransporterAduxmIedgmenL of Receipt of MaterialsLU <br /> )" <br /> Tran rtes 1 PsirledlTyped Marne Signature Month Day Year <br /> OIfco ) <br /> Tran art PdnledlTyped Name Sig e Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indicalim Spate ❑ y ❑Type �Residue Ouant Q Partial Rejection E]Feli Rejection <br /> hlanifesl Reference}dumber <br /> 185-ASfemale Faaliy(or Generator) U.S.EPA ID Number <br /> FacililysPhone: <br /> III i 8c.Signature of Altamate FacMy(or Generator) Month Day Year. <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes!t }does waste treatment,disposal,and recycling systems} <br /> LU 4. <br /> L4 I <br /> 20.Designated Faci!iy Uxrier or Operator:Cerdfcation of receipt of hazardous materials wrered by the rnanifast except as noted in Item 183 <br /> Printe!fTyped Nam, S=alura Math Day Yezr <br /> EPA Form 8700-22(Rev-3-05) Previous editions are o sn(ete. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br />