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J <br />A <br />Ptaase nrint nr tvne (Pnrm riasinned fnr use nn elite 112 -niton i rvnewriter_1 <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. f DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />:; 9 2 `� t-1 � r .�+ 1 <br />Page 1 of <br />3. Emergency Response Phone <br />19(70) 4.4_93oc <br />4. Manifest Tracking Number <br />0 0 9 15 Z JJ K <br />WASTE MANIFEST <br />'A _C'- <br />t b :3 � <br />5. GenecVqn 14r%ai)iVAr s Cc R TS t �t"t; :c3 s Generator's Site Address (if different than mailing address) <br />P.0.8()X N) 7r%3 TERMINAL AM41E4IGIGO P1CCCIL1 RD <br />LOS APIGELE-3 CA -,Xti#51 STOCKTOP4 CA G621 a <br />G one: <br />OF <br />09. Transporter 1 Company Name U.S. EPA ID Number <br />?017 FER IS <br />n orter 2 Company Name U.S. EPA ID Number <br />8. Desigpate�Fuc t Nafn�ap Sita9ddre� SERVICES U.S. EPA ID Number <br />115 if) SOUTH Rjl&q.. ROAD <br />WEST S.ACIRMA 70 CA �� 1 C A D 0 A c1 C 0 3 '5 b <br />Q 161N 1 V <br />Facility's Phone: <br />9a <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Ncl. <br />1. <br />7J 1 <br />F',i:: <br />;-RCRA HAZARDOUS IWA,SM, LIQUID (LASED OP t�i?;ED OI ? <br />001 <br />TT <br />3Li0 <br />G <br />0 <br />Z <br />2. <br />W <br />3. <br />11 <br />tF-=A <br />4. 9 21 <br />ENIV I AA T A 1- W <br />14. Special Handh Instructions and Additional Information <br />� AER ; 991: 11'1 g PRORLE # 1481 : WOTENERGE1ti�;Y CONTACT: CHEM rAEC 1-6W.4244nW T WA CCOE", <br />9a j . , i^iONE * APPROPRIATE PERSONAL PROTECTM EQUPN1ENT <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 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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />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 a small quantity generator) is true. <br />Generator'slOfferofs Printed/Typed Name Signature Month Day Year <br />J <br />r <br />16, International Shipments <br />❑ Import to U.S. ❑Export from U.S. Port of entry/exit: ' r+ <br />z <br />Transporter signature (for exports only) ate leaving U.S.: <br />w <br />17. Transporter Acknowledgment of Re 'pt of Materials / <br />Transporter 1 PdntepedName Signature s 1 Month Diay Year <br />d.,\J <br />L <br />id ,�itd'' I _ .G•'A >R �'i� I r ti�J <br />Z <br />Transporter 2 PrintedlTyped Name Signature7 Month Day Year <br />H <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Altemate Facility (or Generator) U.S. EPA ID Number <br />c.> <br />LL <br />Facility's Phone: <br />w <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />Q <br />Z <br />N19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />1. <br />2. 3. <br />4. <br />r <br />20. Designated Facility Owner or Operator: Certificatin of receipt of hazardous materials covered by the manifest except asngea in Item tea,�--- <br />Ph ed p d Na <br />Signature Month Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. f DESIGNATED FACILITY TO GENERATOR <br />