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Please print or type. (Form designed for use on elite (12 -pitch) tvoewriter.) Form Aooroved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. - DESIGNATED FACILITY TO GENERATOR UNIFORM HAZARDOUS i. Generator ID Number 2. Page 1 of 3. Emergency Response one 4. Marnfest Tracking Number WASTE MANIFEST J J K 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Generators Phone: 6. Transporter 1 Company Name U.S. EPA ID Number 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number Facility's Phone: ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Ncl. p F— z LIJ 2. �------ THIS WASTE STREAM HAS BEEN QUALIFIED I 3. FOR RE&GLINGR69KNTS AT 1HE Deh1EN�dO / KEROOON FACILITY IN COMPTON, �CIA�D- EA CALIFORNIA. THIS FACILITY HAS THE NECESSARY MI l 4. PERMITS TO RECEIVE YOUR QUALIFIED. OUR EPA NUMBER IS CATO80013352 Ju hIA — 14. Special Handling Instructions and Additional lnformation ENVIRONMENTAL HEALTH .._.. r _DEPARTMENT 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 labeled/placarded. 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 (b) (if I,am a small quantity generator) is true. Generators/Offerors Printed/Typed Name Signature/ j' Month Day Year s J 16. International Shipments 1:1 Import to U.S. ❑ Export from U.S. Port ofentry/exit: z Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year a 4. za Transporter 2 Printed/Typed Name Signature Month Day Year t- 18. Discrepancy 18a. Discrepancy Indication Space ❑ quantityyp j j ❑ Type Residue El Rejection El Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U LL Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z v519. Hazardous Waste Report Management Method Codes for hazardous treatment, disposal, (i.e., codes waste and recycling systems) C L 2. 3. 20; Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature _ Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. - DESIGNATED FACILITY TO GENERATOR