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00, <br /> s . <br /> Please pret or type.(Form designed for use on elite(12-1 filch)typewriter.) Fmm Approved.OMR No,20500039 <br /> UNIFORM HAZARDOUS 1.Generator 10 Number 2.Pegs 1 d 3.Ensgw"Rmapwas Pham ma wl"It mumMr <br /> MIA97E MANIFEST .l�1.,:; 1 001421179 JJ K <br /> S.GeeeMprs Nwne eM Makes AM,aas Genegbrs Sib Addfm(9 diteM Man nailig atlkeas) <br /> VALLEY PACIFN:Y ,. :14,: . : ; <br /> GerbratrYsphde:. '..c1.r, - <br /> 6 Transporter Canpant U.S.EPA ID Number <br /> 7 Tmwepodw 2 Cmgany Harte U.S.EPA ID Number <br /> B.Oeei O.F b NeuWW Sia Ad&m US EPA iDNMI <br /> Ner <br /> RAI <br /> l:;pt=. <br /> r:rf'vi:'<A, iA �....;-t <br /> 9a. M.U.S.DOT DespgEon(moluddg Proou Shipping Nam.Haz3id Class,IO Number, W.Cwlaners 11.Total 12.Una. 13.Wavle Codes <br /> HM and Pad'Ag�Wliany)1 N0. Type Quactdj MNd <br /> QO — <br /> K <br /> Z 2. <br /> w <br /> U <br /> 3. <br /> 4 <br /> 14.Specai Handling InsMactions a o Atldiavi Inbrmat on <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the mnta as of tis mnsignmed are fairy and amurubty described above by dw propw shipyrvm(name,all are dasafied,pacmged. <br /> Tarketl and IabeieNpvacaMed.and are in all respens In proper CpMi!IU11w hanspoR acmrdilg IO applicable intematanai and national gwemmenb regulaBons.II expon shipment ant 1 am;ha Prunary <br /> Exporter,I cell(,Uat the contents d this consignment confam to the refine of the attached EPAAcelwwledgmerd of Consent <br /> I oardy Mat to waste m.: izaban statement elentified in 40 GFR 26227(x)(i I am a large quantity generator)or(b)(d I am a small quantity generalon s Vue. <br /> Gen&ztorsSGllemr4 Pnrded/typed Name Sgnawre Month Day Year <br /> .� 16.Iomroalinal Shipments Y.. <br /> ❑Import to U S. ❑Export horn U.S, Port of entrylex4: <br /> Z Transputer sgnau,re(for exports only) Date leaving U S.: <br /> w 17.-,Importer MtwxleDglnut of ReCW of Minerals <br /> Transporter 1 PTledtTyped Nadu Sgnature 'Aan), Day Year <br /> QTransputer 2 Pnntetl7Typed Name Sgnature Month Day Iran <br /> C <br /> H <br /> +6.Di ;fancy �3 <br /> I aa.Ciscreparcy incubation Spam L aerbb, O TY ❑Residua i_1 Partial Rejection ❑FUN Rejection <br /> Manifest Rebrenca Number <br /> (� I W Memate Fauhty(m Geneotorl U.S.EPA 10 Number <br /> J <br /> U <br /> rat FacuiNs P:ror�e' <br /> Qw 1dc.Slgnawre of Mamate Faahty for Geoevotorl Monts Jay Year <br /> z <br /> 19.Hazardws Waste Report Management Method Codes 6e,miles ter hazardous waste tmvato A,disposal,end recycfmg systains) <br /> Notice New federal form. State of <br /> w California requires generator to photocopy <br /> a <br /> 1 29 Deng aeetl Faaldv Owrer or amrmor Cerrttkation of reompt of hazardous malenals mvemd by Me manifest except as mLM m uem l6a and mail to D'ESC within iO days: <br /> PnnbtlRypad Name Slgnewm <br /> P,0. Bos 400,Sncramen(o.CA Q5812-0400 <br /> J <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />