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si{ `a}f:t0'# <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number t __7 k 2.Page l of 3,.E l ra cy Res�se",-- 4.Manifest Trz ng Number SKS <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different Nan mailing address) <br /> "i'c kismr.i 7S4•l 1.d?ne <br /> s•,1 Pulley AVE. CA 1353;20�1000 <br /> Generators Phone: !_Q,1 9,-'ri`.:St'i- <br /> 6.Transporter i Com any Name U.S.EPA ID Number T,Y r,12 s. <br /> F.V1F-FT-v'-,W .FiA R If�%TFQ,14 La.. l <br /> 7.Transpoder 2 Company Name .�-; # U.S.EPA ID Number <br /> D-Elt#d 4411R13C1R f_P9 i 11CNht N1T C MCI- <br /> 8. <br /> 4 C I- INC , <br /> 8.Designated Facility Name and Site Address C, !•-L"LIN HARBORS 4th �ifZ�L. U.S.EPA ID Number <br /> 40-al, BI F{RYF EEA 110AID <br /> SAN )C,r;E fi l ? t:AS3t� 34:4;3i� <br /> Facilit Is Phone: <br /> 9a. 9b.U.S.DOT Descdpfion(including Proper Shipping Name,Hazard Class,ID Number, 18.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(ff any)) No. Type Quantity WILIVOL <br /> f.SQ0 i;;tirsft", rr• ; <br /> kFta,t; <br /> 4a $ <br /> W <br /> Z 2. <br /> W � <br /> C7 <br /> 3. <br /> OCT <br /> 4. ENVIR NM --- <br /> HMAT <br /> 14.Special Handling Instructions and Additional Information 7yl.t„c.ti <br /> )iE 1.t„3€f Sxf <br /> c ti hFt Em kr'r NC Y `a 3 EIRfil :ifi� 1160 i .}{ t (t-j r <br /> 01izH 'i. '47q;-ht-._.Pill S; ,A! Il,7N'4 r1.- i i.: .htV:r--d'r Ra:k :-f1gP fF:-SX OC4 AiPPS'4"-".1.5i?l' <br /> 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, <br /> marked and labeledlplacarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the tens of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste miniml7ation statement identified in 48 CFR 262.27(a)(if I am a large quantitygenerator)or(b)(if I am a small quantity generator)is true. <br /> Generam'si0fieror's Pdntedflyped Name Signature i t Month Day Year <br /> j 16.International Shipments <br /> Elr Import to U.S. ❑Fxport from U.S. Port of entry/mit <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TranspoderAcknowledgmentof Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature , J Monts Day Year <br /> C) * r. f <br /> Ge, r /v '` _ 'm-e Mont Day Year <br /> 4 Trensporter 2 PrmtedlTYP�Name '.,Signature Y <br /> K <br /> r <br /> I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ElQuantity ❑Type 1:1 Residue El Partial Rejection ❑Fult Rejection <br /> Manifest Reference Number. <br /> 1Bb.Alternate Facility(a Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fadlilys Phone: <br /> w 1Bc.Signature of Alternate Fach ily(or Generator) Month Day Year <br /> zz <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous wasfioltr'm,dispoaxt,and recycling systems) <br /> D 1. 2. 3. 4. <br /> 20.Des <br /> PdnledlTyped lypedtl Name Facility Owner or Operator.Certification of receipt of hazardous materials covered by the whitest except as noted in Item Ice <br /> Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05 Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />