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Please print or type.(Form designed for use on elite(12-pitch) pewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST 5.Generator's Name and Mailing Address Generator's SileAddress(if different than mailing address) iaftill ::ft f` fti l l y i.,01*14;:SAT. Generator's Phones..ar.;_....- 6.Transporter 1 Company Name U.S.EPA ID Number 44-J4K t V'ln+i.l.#sY WA6IL-011., €h f:. tii'4frtfrl9t�t r?vii.; 7.Transporter 2 Company Name U.S.EPA ID Number ;i 1 k;i tit: K i I; Wk CIAL I`r WAJI It %XU1 K,44.".t.I''ll 8.Designated Facility Name and Site Address U.S.EPA ID Number 1 ",141 i O„ y k:WkW4*ill+l.,W401 Ot- P Va'II LI..f Faciiitys Phoneu,r ab :.,r.r� J I:i.i ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.ContainersType No. Quantity Wt.Naf 11.Total 12.Unit HM and Packing Group(if any)) 13 Waste Codes . O 1 tki i 8ft WAS;e N11V.a I tNS1`FA Al ill .4 1, F1.01111 9 i i Iij1A� f' w L >i 2. KQ.NA 0fI k1F'NIAKkl WAS It;,SOL 11.),1v3.0 wi .1J, i•kMl 6AKik-*L t t?} t 3' K0.ON 1:126 € 'IT- Willi t..014kiAl 1G,, N,0.s� ,f1 1. P63. P OLY65111i Alk;0ROl Ki W Fi k•i F:,'1hAWX.A4%)'r-''f,f''Pmll 4. 14.Special Handling Instructions and Additional Information 15. GENERATOR'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 labelediplacarded,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 EPAAcknowiedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 2f 2.27(a)(i£I am a large quantity generator)or(b)(if I ar_ri'a small quantity generator)is true. Generator's/Offerors PrinteL ed Name s SigrfaYJPe Month Day Year E^j f y I , u 3 t tri 1 Y i r-J 16.International Shipments � ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: Ix 17.Transporter Acknowledgment of Receipt of Materials ! Transporter 1 Printedrfped Narne y Signature Month Day Year Q Transporter 2 PrinledlTyped Name Signature Month Day Year 18,Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ElType ❑Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ Y:J Facility's Phone: W 18c.Signature of Alternate Facility{or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 2. 3. Notice: State of California requires generator to photocopy and mail to Flenated Facility Owner or Operator,Certification of receipt of hazardous materials covered by the manifest except as noted in Item 180 pTSC with 30 days' ped Name Signature P.0 Box 400 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. Sacramento,CA 95812-0400 GENERATOR'S INITIAL COPY