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Please print or type. (Form designed for use on elite (12-pitcamer.) as Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21, Generator ID Number <br />22. Page <br />23. Manifest Tracking Number <br />(Continuation Sheet) <br />CADOD9i88088 <br />1 2 <br />002D4Pq'?3FL5- <br />24. Generator's NameAppillied Amoapaee StructUre <br />P.O. Box 6189 <br />Shod toreCA 95206 <br />25. Transporter Company Name <br />U.S. EPA ID Number <br />26. Transporter Company Name <br />U.S. EPA ID Number <br />27a. <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />28. Containers <br />29, Total <br />30. Unit <br />Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt./Vol.31. <br />X <br />5. RQ NA3077 Hazwdoas waste, solid, nus., 9, ili <br />181 <br />D007 <br />(ChTam;mn)(D007)D3 <br />DM <br />�.{O% <br />P <br />x <br />6- RQ NA3077 hazardous waste, solid, o-o.s-, 9,111 <br />181 <br />DOW <br />((1mmhnnXD007) <br />02 <br />D/y <br />14.2-7 <br />p <br />I- <br />* <br />7. RQ NA3077 Hazardous waste, solid, n c.s.; 9, III <br />181 <br />D007 <br />(Cluomium)(D007) <br />03 <br />DM <br />5'S7 <br />-- <br />p <br />8- <br />o <br />X <br />RQ NA3082 Hazardous waste, liquid, ao-s-, 9, M <br />343 <br />F001 <br />D039 <br />(T Y atq(vo39) <br />0 f <br />DF <br />�2SD <br />W <br />P <br />z <br />7C <br />9. RQ NA3082 Hazardous waste, liquK n.o.s., 9, III <br />343 <br />DOW <br />(water, chmm;umxD007) <br />61 <br />Ah <br />513 <br />p <br />10. Nm-R(9tA hamtdaus waste liquid (Watcr,Paint) <br />331 <br />01 <br />��- <br />Y'7g <br />P <br />11- Non-RCRA hazaedous; waste liquid (water, oil) <br />348 <br />o/ <br />bM <br />`r'7% <br />P <br />12. NatrRCRA hazardous waste said (Graphite <br />331 <br />Pna-Ptwj <br />os <br />DM <br />399 <br />P <br />13. Noll hazardous waste solid (Nickel) <br />352 <br />C� <br />a� <br />SS <br />P <br />14. Nan RCRA haardow walae solid (Flattia, adili <br />362 <br />04D� <br />S56 <br />P <br />32. Special Handling Instructions and Additional Information <br />a'8f l� 218610 <br />27b5)it6734FR4:17I(3xSS12766)R1919FRG:171COLZZ) <br />VAIL)W33 <br />CS'), <br />27b7)R6735 ERG: 171 (3 xSX)2M)R4278 ERG: 171 (1 z� <br />27b9)RI6294 ER(3: 171(1 x55)27bl0)R3301 (1 : <br />aA t3 R94 <br />% <br />(1 (f c ) <br />z76 R 3 <br />3AE <br />w <br />Printed yp d Name <br />Signature <br />Month Day Year <br />K <br />O <br />a <br />Z <br />34. Transporter Acknowfedgment of Receipt of Materials <br />Printed typed Name <br />Signature <br />Month Day Year <br />r <br />35. Discrepancy <br />r <br />J <br />U <br />Q <br />LL <br />r'7 <br />W <br />4 <br />36. Hazardous Waste Report Management Method Codes (i.e., modes for hazardous waste treatment, disposal, and recycling systems) <br />Z <br />O <br />N <br />W <br />O <br />L <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />