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Please print a type. Form designed for use on epte (12 -pitch) pewnter.) <br />Form Approved. OMB No. 2060-0039 <br />A Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />G3%%@ <br />2. Page 1 of <br />3. Emergency Response Phone <br />OL NFA M"Ing Number <br />017145320 <br />WASTE MANIFEST <br />CALi> <br />P 16-Iq t- £`+k:' :. <br />JJK <br />5. Generators Name and Melling Address Generators Site Address (If different than mailing address) <br />"MCH B; :S£ tL.s ? # [.'Y d -J& <br />18V INi7ilSi'f"!AL <br />�1'�.:K'TrJti, CA. x:19 <br />Generators a +7 <br />8. Transporter 1 Company Name U.S. EPA ID Number <br />.I <br />cre,wtTs lamj 4t .. '—*T.-�L Sm.. XE ; INC <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />B. Deegneted Facility Name and Site AddressbJ 43% Uw'SmmmAC 9Ct°i,1CLU r INC U.S. EPA ID Number <br />1+3if3 'XtkTttft'f?iF fikT. <br />WEST SpkCAAWajj. CA Mims <br />1$` -r <br />FwWe Phone.0 <br />ga <br />9b U.S. DOT Descd*n (Including Proper Shipping Name, Hazard Class, ID Number, <br />11:1bMt <br />iL Lwt <br />13. Waste Codes <br />No. <br />Typo <br />HM <br />and Packing Group (If any)) <br />WILAkI. <br />T. Nall I -CPA FWXrP.£ OUZI WAZ'"iaE SOLD (M, MWn. <br />: tIIDI <br />01i5 <br />a <br />2. <br />t <br />tk Special HanftInsbuctionsand Additional Information <br />1<4a <br />{ <br />P P. C1JfolTRanG CAt RALj°i EAP trJ U.ifvitil a!, . <br />311 R9 x <br />-.M" W T#k,tili?tf_r&I AM LNe APPR01M 44 <br />15. GENERATOR'StDFFEROR'S CERTIFICATION: I hereby declare that the contents of this consornent are fAy east ecouratalydesatW above by thepropershipping nam and are classified, PackVWX! , <br />marked and labeledfplacarded, and are In all respects in proper condition for transport according to applicable intertrelbnal and national governmental regulations. If export shlpneriit end 1 am the Primary- <br />Exporter, I certify thatthe contmtv'cf this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br />I cartify that the waste minimization statement identified in 40 CFR 282.27(s) Of I am a large quantity generator) or (b) (if l am a smell quantity generator) Is true. <br />Generator'sl bror'sPrintedgypedName Signature Month 'Day Year. <br />rti c" <br />? <br />t18. <br />"'nal sh'P'nts El <br />�. Import to U.S. Export m U.S. F_brt ofentryfexib • <br />: Transporter signature (for exports only): Date leaving U.S.: <br />It <br />17. TratsporterAdmowledgment of Receipt of Materials <br />Transporter 1 Printotllr a Slg re Month yDayOr Y�er <br />ransportar 2 PdnM typed Name lure I%*... Year. <br />18. Discrepancy <br />18s. Discrepancy Indfcalloa Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑FuIIReJacUm' ' <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />v <br />Fad ys Phone: <br />180. Signature ofAltenrete Facility (or Generator) <br />YW <br />49. Hazardous Waste Retort Management Method Codes (La., codes for hazardous waste treatment, disposal: and recycling systems) <br />G <br />1 <br />2. <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 as <br />PdnterUTyped fame Signature M• • <br />A Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />