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RECEIVED <br /> _ SEP 0 6 2018 <br /> Please print or type. (Form designed for use on elite 12- itch) typewriter.) Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page i of :7'��e�E��JTv �PfV ! t� M Tfil c umber34138 (�WASTE MANIFE3T DEdMiltik <br /> G B F <br /> 5. Generators Name and Meting Address Generator's Site Address (if different than ilfng address) <br /> rte(, <br /> TV,Li , CA <br /> Generators Pho <br /> NUMINSWINNI6. Transporter 1 Company Name U.S. EPA ID Number <br /> " T <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 1 L[ArVf i i WE 0, ci . rv ,- € ' f .'. Y" t <' IfrrA" Eia ;: G"0001 7 <br /> B. Designated Facility Nan Sffeloress U.S. EPA ID Number <br /> � E .�'3c ! .'• IE1E> I <br /> Fadli s Phony A ' A ' 1 <br /> ' 1 <br /> 98. 9b. U.S. DOT Description (induding Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity WtN01. <br /> 1 . <br /> r' 11. T't ft ; 5 , 19- 611 ;f' <br /> Z 2. <br /> W <br /> C9 <br /> 44 3. <br /> . <br /> 14. Special Handling Instructions and Additional Information <br /> VROF ILEW 1632441hMS f'API1_ k I it . t t,. rz t " 4tr .-M i I i <br /> E <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 govemmental regulations. If export shipment and I am the Primary <br /> Exporter, I certify that the contents of this oonsignment 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(x) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br /> GeneratoeslOfferoes PdnteWliMped Name Signature Monjh D Year <br /> 1 40 <br /> mi 16. International Shipments <br /> E~ ❑ import to U.S. El Export from U.S. Port of entrylexit: <br /> Z Transporter signature (for exports only): Date leaving U.SMIN PREOPPIN <br /> .: <br /> IT TranspoRerAduwwledgment of Receipt of Materials ' <br /> Transporter 1 Prhted/Typsd Name Signet Month Day Year <br /> 4 r <br /> RU <br /> w <br /> Transporter 2 Printed/ryped Name Signature Month Day Year <br /> 18. Discrepancy <br /> 18a, Discrepancy Indication Space EJ Quantity El Type v ❑ ResidueP ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b. Mternate Facility (or Generator) U.S, EPA ID Number <br /> V <br /> W Facility's Phone:powomomme <br /> 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> 19. Hazardous Waste Report Management Method Codes (I,e„ codes for hazardous waste treatment, di sal, and recycling systems) <br /> 1 . 2. 3. 4. <br /> 20. Designated Facility Owner or Operator, Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedltyped Name Signature Month Daffy 'ear <br /> EPA Form 8700.22 (Rev. 3-05) Previous editions are obsolete, <br /> 1'RAtdSPORTER' S COPY <br />