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Poease print or type.(Form designed for use on elite(12-pitch)typewriter. <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST ^aL 2 "' _R 009930855 JJK <br /> S.Generator's Name and Mailing Address MEPCO I.aEFL SY 8TE1.1S Generators Site Address(gdiiterent than mailing address) <br /> 1313 S. SMCKTON ST. 29 ht AURORA ST <br /> LCO.CA S&40 STOCKTLIN,CA R".'2O7 <br /> Generators PhoneP N-946.3201 <br /> 6.Transporter 1 Company Name <br /> U.S.EPA ID Number <br /> R:1M, - EMAROI45. g7T.A.L.^,ERVICL°9 CADW4003566 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Designated Faulty Name and SdeAddress`tEOLIA ES TECHNICAL SOLUTIONS, LLC U.S.EPA ID Number <br /> 1125 HENSLFY STREET 'aT!`,RLTQ11079 <br /> FICHM01410,CA 94801 <br /> Fatly s Ph":6M-243-1 xV <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.conte rirwls <br /> HM and Pacing Gloup P any)) l 12 Unit 13.Waste Codes <br /> Na. Type OuantlQuaniP11.70ty WLAV. <br /> 1. FRIM-PCFq HAZaRGO+J: :v . TE "oOi.03 1IF/nF1. 0I1-1 O• 9$1 <br /> K <br /> w <br /> W 2. <br /> W <br /> c9 <br /> 3. <br /> 4. <br /> 14.5 ualH Instructionsa V0 % <br /> dddionel lnformetion <br /> fLrANOL"A"TCr f3E V0 .%N 9bl) EPGN171 WIPN378345 , X , <br /> 'EI4' CONTFiACTOP.: Ra.JA09 EPPAR01 1604'.AL SERVICE? <br /> 15. GENERATOR'SIOFFEROWS CERTIFICATION:thereby declare that the contents of this consignment are filly and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labdedlplacarded,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 <br /> Exporter,I cergfy that the contents of this consignment conform(a she tem s of tla a8eched EPAAckmcWledgment of Cement <br /> I certify that the waste minimization statement identified in 40 CFR 26227(x)IN I am a large quantity generator)or(b)(61 and a saml quantity generator)is true. <br /> GeneraloeslORerWs Pdntedflyped Name Signature Month Day Year <br /> 16.International Shipments <br /> i- .Pod In <br /> U.S. ❑Fxpod!corn U.S. Pod ofentry/exiC <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TrnsponderPdvatmedgment of ReceiplofMakdals <br /> Troglpmter 1 Pdnled'T"Nemo SigMomh Day Year <br /> ,1 _' nature 4 1 <br /> 7� !Z.' �fil.. tt .'._. jJ <br /> z Transporter 2 PmaNTyped Name Sigmmra Month Day Year <br /> i18.Discrepancy <br /> 18a.Discrepancy Indication Space 11 assamgy ❑irm ElResidue ElPartial Rejection ❑Full Raise. <br /> Manifest Reference Number. <br /> 18b.Atiemate Facddy(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Faditys Plane: <br /> like.Signature ofAftemate Facility for Generator) Month Day Year <br /> 122 <br /> y19.Nammlous Wasa Report Management Metlwd Codes pa.,codes for hazeNwa waste assumed,disposal,and recycling systems) <br /> 0 1. 2. 3. /. <br /> 20.Designated Facility Owner or Operator.Certification of media of hazardous materiels covered by the manifest except as noted in bem Ise <br /> 1 I'MINKU I yped Name Signature Month Day Yew <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />