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t <br /> y� Form Approved.OMB No.2050.0039 <br /> Please print or type.(Form d@signed for use on eltoNum 12-pitch)typevaiter.) ' <br /> F1UNIFORM HAZARDOUS i.Generator ID Number 2Pagetof 3.Emergency Response Phone 4.Manifest Trachln Num^�ber <br /> WASTE MANIFEST 'L'.4404'(,144y k_ I� 6� ° e,}L�t,.f�2 7 3 G B F <br /> 5.Generatols Name and Mailing Address . s CSKk.C:-4rs Generators Ste Adress( 61-1-1k,than maling adress) <br /> {<N ) :s:#till L:l�lti3 +el{. Ott :ill, liar `+xt�pr' <br /> G3-}ig q R;'4.erhank-, CA 9536" <br /> Generators Phone:- U.S.EPA ID Number <br /> 6.Transporter i Company Name meq! yy��ii <br /> h i^d'ID: �� �i��iN' Y4 M,.Y't�1h P� ♦ 1:$�i:"k � s `t',<i <br /> 7.Transporter 2 Company Name U.S.EPAID Number <br /> 8.Designated Facility Name and Site Address Oil R yU.S.EPA D Number <br /> +elw?Ci!$REi1. � �g"9r4'f�i'3' <br /> (?it's) a3Rs(7 (law Rd.,Mi '&k 'Al AN 1-90 16 <br /> 30-34R f:.i-:w1n,fixik, \yak 45,W,' <br /> Facilitys Phone: <br /> 9b.U.S. Description S.DOT Diption(including Proper Shipping Name,Heard Gass,ID Number, No No.Containers Total 12.Unit 13.Waste Codes <br /> 9a. T Quantity WWoI. <br /> HM and Paddng Group(if any)) YPs Qu , <br /> 1. <br /> 0 NON.I('kCRA llaznweelozk4 W,10e.1..,#.4}a:p 4 >c? <br /> �E ITI a <br /> 2. <br /> �ry <br /> 1..py5 <br /> 3. <br /> OCT 6j.p2 5 <br /> 4. - VIRO °f Yiv NAL <br /> FA'TP Qd DT GAIL <br /> 14.Special Handing Instructions antl Addltanal Information <br /> 15. GENERATOR'810FFEROR'S CERTIFICATION: Thereby declare that the cements of Nis consignmenlare fullyaM acouderly described ebwe by the proper shipping na ,and ue rias ad,P • <br /> marked and labeled/placarded,and are in all respects In proper condtion for transport according toapplirade'international and national govemmenlal regalations.If=_xpo^. 7.pment and I am the Primary <br /> Exporter,I cedlfy Net the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I cerfily that the waste minimization statement idenOW in 40 CFR 262.27(a)hi l am a large quantity generator)m(b)[rfl am a smak quantity genreratar)is true. Mum Day Year <br /> Generatorsl08erors rnmedfTyped Name SgnaWre - _ �J <br /> f 4 L <br /> 16.Intematimal Shipments <br /> ❑Import to U.S. ❑Export from U.S. PMoferi \ <br /> Transporter signature(for exports only): Dale leaving US_ <br /> wan <br /> 17.TrsporterAcknowledgmentof Receipt of Materials <br /> OTransporter I Printedflyped Name Signaaea /-v_: f <br /> VL 1 J, \ , .>,.r c tical m1 74i <br /> Q Transporter 2 Te <br /> Name SignaWra <br /> .N 18.Discrepancy i <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue ❑mow Ramon uF.9 Ravacliae <br /> Manifest ReferenceNuN:Y.. <br /> U.& A D Fkercer <br /> 186.Alternate Facility(or Generator) EP <br /> J <br /> U <br /> a Facility's Phone: <br /> 190.Signature ofAllamate Facility far Generator) <br /> 6 <br /> Z <br /> 19.Hazardous Waste ReportManagement Method Codas(i.e.,codes for hazardous waste hatrnent,disposal,ate recycling systems) <br /> 1 / 2 3 4. <br /> 20.Designsdd Facility Owner or Operator.Certification of retelptof hazardops materials covered by the manifest except as noted m Item 16a <br /> Pdntedll'yped Name / % Signaaae . T 1trm 37 `�' <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> GENERATOR'S INITIAI P.(1PY <br />