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PteC ml or type . (Form designed for use on elite ( 12-pitch ) typewriter.) Form Approved . OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST 1 143@6.7857225 010 2 4 3 3 6 5 F L E 5, Generators Name and Mailing ddress Generator's Site Address (it different than mailing address) 1� Ln Arm�a�e Ca GSM gMor�rdwrtt° C°"'prry tGLAMCO) dcloi��iG� StmkW% CA SM Generator's Phone: �"�'� � 6. transporter 1 Com y ame U.S. EPA ID Number A&AMMid Twepw kwo tS1n CAtm00�JOb40 7,w j{pns er Co a� ny Namo U .S. EPA ID Number CAFM17un �etorery Inc 8,Dt�ig_natated Facility Name and Site Address U.S. EPA ID Number 2730E L SIC A�Dt106169124 YtrineAZ 025644411=1Facilityrs Phone: ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Urdt 13, Waste Codes HM and Packing Group (if any)) No. Type OuartHy Wt,Nol. I a ` q P w ! !!! 3 E I '1 i 14 . Special Handling Instructions and Additignal Information ✓� �� '�]'�� y � ; �� $ 1 ) 176M CAY 00 15. GENERATOR'SlOFFEROR'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 Iabeled;pfacarded, and are in all respects in proper condition for transport according to appricab!e international and national governmental regulations . If export shipmont and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a) (if I am a large quanGly generator) or (b) (if I am a small quantity generptor) is buo, Generator's/Offer s nntedfryp atne on ay ear igna r - Z InternationalShipments Port of enl lexiL❑ Impo t to U.S. Export from U.S, ry ns orter si nature for ex orts onI : Date leaving U.S.: Of 17. TmnsportarAdnowledgmenl of Receipt of Materials Montha ansporter 1 Print d Name r ur I � � Y 1 vim, c 0 JT I SIC4 OL V1�i 11 c� -7✓ W Transporter 2 Printedfryped Name gnature donlh ay Year 18 . Discrepancy rr � 18a . Discrepancy Indication Space ❑ Quantity ❑ Typo ❑ Ridue ❑ Partial Rejection u Full Rejection Manifest Reference Number: 181b. Alternate Facility (or Geceralor) U.S. EPA ID Number J U LL Facilit 's Phone: w 18c. Signature of Alternate Fadlity (or Generator) hlontfh Day Year a Z 19. Hazarous Vaste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) 3. 4. D 1 ' ' � ' r<It C 2 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Signature ` Month Day Year PrintedrTyped Nam ; ++ g t — EPA Form 8700 .22 (Rev. 3.05) Previous editions are obsolete . DESIGNATED FACILITY TO DESTINATION 5TATE ( IF REQUIRED)