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i Please print or type.(Form designed for use on elite(12-pitch)typewriter) � Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number2.Page 1 of 13.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST D F 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) �'address) cif t�J"R* : Generator's Phone: , r.,;,. 6.Transporter 1 Company Name U.S.EPA ID Number 1dr1J.1.9�:'a 4V14�I L Olt-tic:. 7.Transporter 2 Company Name U.S.EPA ID Number 3 i r iC i'f l t :al-f CM I Y %PWA6I I-.�tt7' J.IJJ jt)N�,t r g:sr 1d N-�t 11 M1y'�4 8.Designated Facility Name and Site Address U.S.EPA ID Number ;s 1ill 1(At Y J WVIPt"' a"I AL f*AMI k.'W NL VAI i J-t, 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. O iti- 7!tTSic'vi1r:�s a`. ttltaf�J:,yS:1hr3 att f 3:f :. 4 f r`y. l1 i �;/y"y� ,fm Z 2. t L 3 Imo,tyYdi310f t tt4, A1(I i:d:a WA6 Ill �4 73 tf„t,A3.ti7 y.V, i'�3f1,Ill KILO ., t £_an73 1,`r= I° C.ill t,.ltlW MFN"ClJfatY' �J't F i AJ+rs?l dt 0l Ill Ow%*Il itit O.y.•rI t. .ua tS, i 4 L 9Ckv i+'T t�lE3:rf E t i x.INI IN p:•Jt~Awx.AND i'ot bA,+ll 4, 14.Special Handling Irstructlons and Additional Information ;� r.�'aFtt.r ,.:. IU€�b '°�f+�I�,.Y,rI'.•uRit t-;9�4 3: ;� Za€Yaa'Ji!!''eFfNl~i J-t£.tt~.�fC;r�{r':f� � it'(::i�t 7�r'1 15. GENERATOR'SlOFFEROR'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 Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable intematioraland 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(b)(if I anfa small quantity generator)is true. GeneratoeslOfferor's Printedl,ed Name �r S'igiaafuru rY2° Month Day Year -J 16.Intemational Shipments F ❑Impart to U.S. ❑Export from U.S Part of entrylexit: Z Transporter signature(for exports only): Date leaving U.S.: LM 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Prntedlfpetl Name Lj Signature l f Month Day Year Transporter 2 PrintedlTyped Name Signature Month Day Year F-- 18.Discrepancy 18a.Discrepancy Indication Space Quantity Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U I Facility's Phone: S 18c.Signature of Alternate Facility(or Generator) Month Day Year Q 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU O t. 1 1 2. 3. Notice:State of California requires generator to photocopy and mail to 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a [y75C with 30[lays' PrinledlTyped Name Signature P.O Box 400 EPA Form 8700-22(Rev,3-05) Previous editions are obsolete. Sacramento, CA 95812-0400 GENERATOR'S INITIAL COPY