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• Please print or type.(Form designed for use on elite(12-pitchowriter.) Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number �j WASTE MANIFEST r rte a�xli�:rl�w 1 0 0 6„'7 4 3 417 f ,9 G B F 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) PREWR 7010 S L.4,*F•!-;.T. Generators Phone��`�"y'�Z"��;'fir' fi.Transporter 1 Company Name y q� S( t 5l J �g U.S.EPA ID NlWmber t( ! y> ) �+,i�?fE'iiK"xl!Yf:.€,d. 1 Woklbtf=-01if IN 7.Transporter 2 Company Name q.S.EPA ID Number �fit-I d t;LL 1A'i,C'04-1V'VVAf Ik- :.i'4AJtlxvN,1,; tf41: Ivlfv':ai} g►#tiIKA S.Designated Facility Name and Site Address i*H: 4 411JI '.�k r4VI l.t,'t Nl19-t'41'A4, M(il a t.;k 1•-d�-iiv;€kA,l.4(: U.S.EPA ID Number .--"fr-3;o i+dl•"i3rt�,�2i t:�I)F{ 1=A. t S•Lf1'}3:TM'A.rr:459°3�_'nft Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1. 1d+;1 t�€I.:,f�;,, 'JL ,.:t k. t :.JJvI?.V 61$„ +,%L a)""oNl:.a'J If . 1-, 'S' 4 T, .i,4i .' Vijii9I ttiANe.r; A440 110) f`�rll e w UL! 2. tit . t*fA ltd?1 '-tPV.'Af41KA `o. 'A1, 1.a. .'.;;",L.3i} iL e c� tori;;1f' S s VVII 1.7',1 1' -177-57P, 6 To 4si'S 3. 14.Special Handling Instructions aid Additional Information 4 Lit`1 '. -"A-01 vVill'i '�,w"ai;$:I+_rMl i:t2(-�O133 + 51: V'Itti it'III.t N 01( t,taR;r{;iJ,FILI h•Fd:;WKh• Will.7 NO 1111. IFRC3/„r f 7'9 f l-A rdt:'r't't'pr$IAti T.I AIA ft.1 F 15. GENE'RATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledfpiacarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)If I am a large quantity,generator)or @)(if I am a small quantity generator)is true. Generato'slOfferors Printed/Typed Name Signature�-" Month Day Year 16.international Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports onl YJ: Date leaning U.S.: 17.TransporterAcknowledgment of Receipt of Materials ;.f Transporter 1 Pn ed/Typed Name Signature Month Day Year ren 114:' ..a*., Q Transporter 2 Printedflryped Name 3[grMurr Month Day Year f1' H 18,Discrepancy 18a.Discrepancy Indication Spare ❑ Quantityj ❑Full Rejection Type Residue El Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number U Facility's Phone: � '18c.Signature of Alternate Facility(or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Method C2odes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Notice: State of California requires w 1. a generator to photocopy and mail to 20.Desfgnaled Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted-in Item 18. DTSC with 30 days: Printed/Typed Name Signature P.0 BOX 400 Sacramento, CA 95812-04011 EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. GENERATOR'S INITIAL COPY