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I <br /> Please print or type.(Form designed for use on elite(12-pitc typewriter.) • Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1:Generator ID Number 2.Page 1 of 13.Emergency Respome Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST x_'A U0067042 � 66j-723-873�`�' 002500946 G B F <br /> S.Generolofs Name and Mailing Addres ��.TCdi. __I' Generalor's SiteAddress(f different than mailing address) <br /> Geneatofs P6an6re'3-[lz.-X PXtTMlAJiH, CA 95367 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> IK e.IST OIL FILM RRC s L!E?G #3462 C'. T 0001'2r-ri j <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Add,555 U.S.EPA ID Number <br /> ?�_S7 Fid=ztT OIL �'�U�L+,, <br /> ;HCl ) 5300 L SZ13 a E'. BLEIG Ii 3v <br /> Facilly'SPhone:963-8181VERBAT ; CA a5361 <br /> ge, 9b.U.S.DOT D11rip6an Including Proper Shipping Name,Hazard Class,ID Number, 1 <br /> 0.Come an 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. TypeQuantity WINaI. <br /> 1. <br /> ME Y W 11TEi?= 1101 TT Sa <br /> z2. <br /> W <br /> t9 <br /> F+4- <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Addticnal Information <br /> VVIR n UL-017 i+.S FREaa#171 <br /> 15. GENERATORWOFFEROMS CERTIFICATION:I hereby declare that the contends of this consignment are fully and accurately desotbed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledfplaarded,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 cerify Nati the contents of this consignment conform to the tens of the attached EPAAcknowledgment of Consent <br /> I corld"at the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a sman quantity generator)is he. <br /> Generotofsf08erofs Printedrryped Name Signature Month Day Year <br /> F r 16.Inlemational Shipments <br /> ❑Import to U.S. ❑F-xport from U.S. Port of enlrylexR: <br /> z <br /> Transporter signature(for exports only): Dale leaving U.S.: <br /> w 17.TranspoderAdmowledgment of Receipt of Materials <br /> Transporter l Printecirryped Name Signature - Month Day Year <br /> O <br /> CL <br /> N <br /> a Transporter2 Pnntedrryped Name - Signature- Month Day Year <br /> o' <br /> 18.Discrepancy <br /> 18a Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partigl Rejection ❑Full Rejecgan <br /> Manifest Reference Number. <br /> r 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> 0 <br /> rat Facility's Phone: <br /> w 18c.Signature ofAJ(ernate Facility(or Generator) Monty Day Year <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> 01. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Congestion of receipt of hazardous materials covered by the manifest except as noted in Item 183 <br /> PdntedrTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE OF R€(BIIBFaED? <br />