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4 r 1 <br />Please punt or type. Form designed for use on elite (12 -pith) typewriter.) <br />Form Approved. OMB No. 2060-OG39 <br />A Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />4;.: <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />2. Page 1 of�101.vt <br />3. Emergency Response Phone <br />�' <br />0. Ma'nn� teQQst Tracking Number t �[ <br />01 145320 JET K <br />WASTE MANIFEST C,ALM6.r3WA5 <br />-V <br />1 ' <br />5. Generator's Name and Mailing Address Genaabors Site Address (if dlferent than mailing address) <br />e&20MCH 0,.:SC".G Ot•1: "1 6 - Jr}, <br />1= IC40t;WT1 KL DR. <br />ST IV..7%1, CA 96-219 <br />Generators ; r. <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />#tows Q e;,aC�CW46ft��ti, <br />7. Transporter2 CompanyNeme U.S. EPA ID Number <br />8. Designated FacrTty Name and Site Address�p U.S. EPA ID Nrrnber <br />SEP <br />RA�;7 �f'fulPt5fai1,1Ei AL. •�:'.{i ACE'S IMC. tti•»itt, <br />1319 1CdjTI.1 P.11R0. <br />wEST 3e14"1NA1M f4it'l. CA Mims <br />Facilitya Phone"g`W1-V-V <br />ga. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10 -Con <br />11. Total i <br />1-2. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (f any)) <br />Quantity <br />WLAfd. <br />rr <br />z <br />2 <br />ui <br />c9 <br />77 <br />X Special Instructions and Additional Information <br />lHHandling <br />i N•��l'SS��[.6� �/4�^4T i �`rr71i t. �i .'1 t '�..'. r• ''?? ii .. ... .. <br />li,ARAUt'.3 .13 ESE TFkA*ME) APS I•M*WROrFD �"�' <br />� � �••� <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fulyand accuratelydesaibed above by the propershipping name, and are classified, package0�� '•1 ` <br />marked and labeledlplacarded, and are in all respects In proper condition for transport according to appirable Intemalonal and netkxgl governmental regulations. If export shipment and am the PdrperY: • ,;'• •_ <br />r.• <br />Exporter, I certify that the contents of this consignment conform to the temps of the attached EPA Acknowledgment of Consent <br />I ca*, that the waste minimization statement identified In 40 CFR 262.27(x) Of I am a large quantity generator) or (b) (if I am a small quantity generatoo to true. «. <br />Day <br />.Genac%Ws/OftorePdhtecflypedName Signature Month DW <br />` <br />F. <br />19. International Shipments <br />❑ Import to U.S. Export from U.S. Port ofentryle>dt <br />Z <br />Transporter signature (for exports only): Date leaving U.S.: <br />W <br />17. TransporlerAdmowledgment of Receipt of Materials - <br />Month !Jay ransporter 1 Pdnte ifT a Sigas <br />r <br />f T <br />Transporter 2 Printed/Typed Name f%&lure Monh Dq <br />16. Discrepancy <br />18a. Discrepancy Indication Spaced Quantity❑Type ❑Residue ❑ Partial Rejeon <br />Manifest Reference Numbs. <br />. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />Ct <br />U. <br />Facks Phone: <br />0 <br />Month <br />18c. Signature of Alternate Facility (or Generator) Day �'Yeff <br />19. Hazardous Waste Report Management Method Codes (La., codes for hazardous waste treatment, disposal, and recycling systems) <br />G <br />1 • <br />2. <br />3. - <br />4 <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18e <br />Pdmed/Typed Name Signature MGM 0* Tear, <br />A Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />4;.: <br />