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Please print or type. (Form designed fa use on elite (12 -pitch) typewriter.) <br />UNIFORM HAZARDOUS Generatof lD Number=?'L,--, <br />WASTE MANIFEST ' C; .A t 25. Generator's Hama end Mait, Addngs6�fL Uf t <br />Sf1ar e - Ciefense C}istribvat�n Sats Joar.�-t; r <br />%ocksin CA 952913 } 7!3 <br />Genrrator's Phone 2 C 9 7 <br />fi. Transuxtsr 1 .on�rany eros <br />t 01-10fe EL, rel Er1ViYbtiefierjai weti/Ica4� <br />2WO N. AlanvdS Sueet <br />Cofptnn Cad Q 222, <br />Face s} e: <br />P0 S 7-t?G?t <br />ga. P1:. U.S. DOT Dr-tkm (ktdciling +roper 5%p nq Nam, i Lazard aws, )O Nwnber, <br />,,4M and Packing Group (if sn1rj <br />i.. . t "t , UPf <br />3, PGili (moot) <br />RECD JUL 17 2019 <br />of 3. Emergertvy Response Farm Approved, OMB No, 2050-M39I Phone 4, �ariifesi Tracking Number <br />c 77-3z.�c�u <br />00680 <br />FL <br />[S,; §ewato $ SAe Address jif u1nerent than MAW address} <br />Dc-f8iis? DisrbbuiJon San J1030:1)-'.�}.cifl)i: <br />700 Ear r,,r_*tit Road <br />Frenal! Can -0 CA 9.522 i <br />ti 2 2 i 2 0 <br />10. Containers 11. Tote! 12. Unit <br />Na. Type CuaI Wt.Not. t3. !Neste Cedes <br />0 0 4 Ti" <br />F s <br />I <br />t [ <br />'QRWOFFEROR'S CERTIFICATttatt: i h&* dodge that lie cerria>t of this axii-igimerd are kk sed aaarataly d=ibod am* by its: Rniper ail pft name" and aro dons W, pa, <br />rrake artd'a� , and gra in a6 respe* in pfoW ca dum for !rampart accw trg to ln�iria jwUj and nat'ernal gevammanW rt>:,)fttat ais. H <br />kaged <br />Exports.'. csrfiy bait the ccs 18nr _' d ties co m*clwn z am b ft of ft abelied EPAAr7mr m4o< Ca sett. MW shipr"nt aW I am lira Fymq <br />carilf3' Lhst the waste minh1tmfiw stattem 9 uten4f'ad in 40 CFR 26W(a) (if 1 am a Lar ta} or (b) (I( am a &Meg lemlor) is true. <br />64 on:: y ear <br />J 16. Mtema#o is Shipnierds Import to US. Faam"frames. Port a' oniryfe&_ <br />Tta =' ortet S m lure for expods ant Data iaevir U.S.: <br />17. Trarsponer A&6—w eQgmeril of ROD* of MaW0 <br />Uj <br />jilTransportarl FrrftdViyPe0 Name <br />0 Month Day y <br />ae <br />17 <br />EL Q Transporter �, ypedNeme gnat <br />18, Discrepmzy <br />1Ha. Disareepamy indication Space CP Ctuandty _ f T <br />yap <br />?- 1tia. AFlamatg Facftty far Gerierafrnj <br />❑ Residue i._i Partial Rejection <br />141111061 R <br />Fid! Rejection <br />U 18c Signature e'Aaemate Fadity ter GertoratorJ <br />Month Day Year <br />CDa <br />t 9. Hazardous Waste Repast Management 10ethod Codes (i.e., codes far haze-daus waste treatment, ds =L and recd-% systems) <br />C t' 2. 3. <br />4.— <br />tedFadllty Owner or Operator. Carbrrcatio I of reo* of hazardous nialedals covered by theaerates!exceptasnoted in Item 10a <br />N>me .,ignature Aionth t]e Yaer <br />(o <br />i h Previous <br />� �� ^✓ <br />:FA Form 8700.22 (Rev. 3-65) Previaus editions are obsolete. <br />