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RECEIVED � <br /> V.3s`�� J •QCL� �S MAR 21 2016 <br /> "fiklnrxraY6u,'rly a y to:DTSC,P.O..Sox`�¢1 �42-•Q400 W ifF1' 30 days"• C-A Y^u <br /> Please print or type.(Farm designed for use on elite(1 Pit' )typewriter.) Farm Approved.OMB No.2050.0034 <br /> UNIFORM HAZARDOUS 1.Genaralpr lD Num r e one 4.Ma fest Trackin1064, 08 <br /> Number <br /> WASTE MANIFEST ' Cg87497493 'r 1-i700-4aM930CB l i r 1' / 0 8 JJ K <br /> 5.Generator's Name am Mailing Address ^ Generalor's Site Ad ern .1C LK;A C ULA BOTTLNG - AW co A RWRE%1&W A PIC <br /> 1551 A'TLA AVEMM 3 ' EL FINIAL DR <br /> PTA11pN1(M LR 90587 C?CKftO1V. CA 95206 <br /> Generators Phone % <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 1:;A'FEY1'-KLFM SN'S 9 NG. TYROD0051205 <br /> 1.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U S.EPA ID Number <br /> INC <br /> END SRSAVM CA098MI37418 <br /> NLWAW, (:A 94560 <br /> Facility's Phone: 51 D-795-4400 <br /> ga. 8b.U.S.DOT Description including Proper Shipping Name,Hazard Class,ID Number, 10.Contid a it.war' 12.Unit <br /> HM and Packing Croup(tf anyp W No. Type Quantity ivolL 13.Waste Codes <br /> W ' INION- r:..FaJ,ROVARDIX[S VVA lE,GULD JaY L (G) <br /> t see c, <br /> Z 2. <br /> W <br /> t7 <br /> 3. <br /> 4 <br /> _ 14.Special Handling Instructions and Additlonal Information <br /> A.r J146 Me 471 Ckwurslarlt k: <br /> 1 X 5 5 1&1301 <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the comenisof this consignment are fully and accurately described above by the proper shipping name,and are classillal,packaged. <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to appticzde International and national governmental regulations.If export shipment and I am It•e Primary <br /> Exporter,I certify that the mnlants of this nonalignment conform to the terms of the attached EPAAclmawktlgmenl of Consent - <br /> I codify(hal lire waste minimization statement identified In 40 CFR 262 27(a)lit I am a large quantity generator)or(b)(ifI am a small quantity generator)is tore. <br /> GenemtorslOfferurs PrintedrTyped NameSignature Month Day Year <br /> ,'n a2 -u L .:i l 'l t <br /> 16.International Shipments ❑Import to U.SExport from U.S. Port of enlrylexn: <br /> Transporter signature(for exports only): Data leaving U.S.: <br /> w <br /> 17.TransporterAcknowledgment of Receipt of Matedels <br /> ¢ Transporter 1 Prionn yped Name as,a,', Signal me" <br /> Month Oay Year <br /> M <br /> J . <br /> 2d. Lanspo"er Pnled([y �slm <br /> gae. Signature Month Momh Day Year <br /> H <br /> .S 19.Discrepancy <br /> fee.Discrepancy Indication Space ❑ Quantity Type ❑Residue Partial ReeGpn FuRejection <br /> Minimal Reference Number. <br /> N 18b.Alternate Facility for Generator) U.S.EPA ID Number <br /> J <br /> V <br /> ra- Facility's Phone: fea* <br /> W 18c.Signative of Alternate Facility(or Generator) Munth Day Year <br /> Q <br /> 2 <br /> H19.Hazardous Waste Repo"Management Method Codes((.e.,cartes for hamorcus waste treatment,disposal,and reryrJing systema) <br /> 0 1. \ ( 2. 3. 4. <br /> 20.Desippated Facility Owner or Operator:Codification of receipt of hazardous materials covered by this manifest except es rated in hem 18a <br /> Printedrfyped Namer j , Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05)) Previous editions are obsolAle. - \% ISESIGNATED FACILITY TO GENERATOR <br />