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�a <br /> Please pinta type. Fenn designed(arose on elite(12- ich)ty IIWdiec) Poron Approved.OMB No.2050-0039 <br /> UNTORM HAZARDOUS 1. a 9)Number 2.Pagetaf 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST - �°� .� Q 1 1-800424-9800 0 0 33364 JJ K <br /> S.Generaors Name and Mewing Address Sr -srr� Generators SdeAddress(it dlflererl then mallln/q address) <br /> C95 1-7ere <br /> "d <br /> ��y� .. . ,. .. . U.S.EPAID Number <br /> 5' 3d(green°° nvironmeet®ISewices I CAD982413262 <br /> S7 Tinimspada2Ca,petty Name U.S.EPA®Number <br /> Welp,eleAd�NetneaM lglAcklexansEvergreen O11,Ino. U.S.EPA ID Number <br /> ?e t ':6880SmithAv6. <br /> _Newark;CA 94560 CAD980887418 <br /> . m� 610-7951400..; .. <br /> gt91k Ue 001'Dee6fptlortQmktlln9 !r no <br /> Name,Hazard Class,DNhaMx 10.CmhWnem 11.7me1 12.vitt 13.Weds Codas <br /> No. Ties elm" WtNal. <br /> `y4S Z 2. <br /> s <br /> r 4 <br /> .14 Special Handing Inskuctlanc and Additional mfamallau <br /> .'i. 15. GENERATOR-WHERORS CERTIFICATION:I hereby declare lhzttht cantenisofthis mnslgnmem ere fly and accurately described above by the proper slapping name,and are classified,packaged, <br /> -.. markedend labeled(Macarded,and are In N respects it propero>odgonfor transport according to appllcame lnlenegondand national govemmemal regNegons.If export shipment and l em the Primary <br /> Expm)rc,I cardtythel the extreme of this consignment comfort the terms of the attached EPAAcknowledgneMMComem. <br /> I ceMy ghallhe waste mWmhatlon slalemmetlantified in 40 CFR 26727(e)(dl em a lama quantlty,generafar)of 010pen V611 quantity generator)is hue. <br /> lofcfONaofe Ploled/fyped Name Slgam!re Month Day Yea <br /> MCI" <br /> zz <br /> y <br /> -+ 1&International Shipments <br /> Dlmpadb U.S. ❑Export from U.S. PoRofenkymxi, _ <br /> Traoep'w(ersignalura(lorexpods oN}1: Date leaving U.S.: <br /> 1T TmesporfmAuieededgmemefRecelptofMaledek - - <br /> TrclrpalerlPdntedTypedNama Signa Month Day Yea <br /> Tunryaner2Pdnled/typed NOW Slgnaluma Month Day Year <br /> � t <br /> - 1S.OMaepncy. <br /> 1Sa Dislaperky lndkadon Space ❑ quansty ❑Type El Residue <br /> ❑Pamal Relndlon ❑WII ReeGlgn <br /> Manifest Reference Number. <br /> 111b.ANamale Facility(as Generator) U.S.EPA ID Number <br /> y3 <br /> r4i Fec111p�Phune: <br /> a� 1&c IgeWra olAllemale Fao ty or Cenersta) Month Day Year <br /> CD <br /> tCD <br /> j ig;Ileratlam Waste ReporlManagemem Method Codes Q,e.,cedes for heserdguswaste treatment,d@posak and regcyng systems) <br /> 01 l t� 2. 3. 4. <br /> 20.Designated Fadtity 0xnw or Operator Cvgimean ofreralpt gfhau'daus Medals covered M'de mamfect incept es ndad In Item Ills <br /> Pnmd N <br /> edRypeame 1 signature Month Day Year <br /> +C2.e gicai 100 J e I11 <br /> EPAForm8700-22(Rev.3-05) Previous&Itions are obsolete. PaWATED FACILITY TO DESTINATION STATE(IF REQUIRED. <br />