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Please print or type.(Form designed for use on elite(12 pewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number c` 2.Page 1 of 3.E er epc fjCs o e Phone /.Ma I- Tracking Number <br /> C WASTE MANIFEST - A N 1 1 1 G U I) J. k; 1 ?YuJ� �,1'-';!.�0?� 008146142 m JJ K <br /> S.Generator's Name and r, li Atltl ss, Generators Site Address(if different than mailing address) <br /> ( 1'Y'C1FM2Ntt�n -T',ks'VPYARD <br /> 20F5 F WETWRE :-=i <br /> WNTF:GA CA 951<�, <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Nu ber <br /> Ai.JR\'tNVlRtihiNkNl+1 'iERV1 F:=; (' A, I1 (; ti ; 7 11 i r. <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> SJElItENSJM)IJST72Y, ING <br /> G.J76 S01.1TH BOYi.E AIWFNI1F <br /> lOS ANCIFLE..E CA P10'Xi+ r A rk ff 14 it ;c (f ., v <br /> Facility's Phone: rQ•;Ipu-tbtYt') <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> z <br /> 1 1 <br /> NON-RNA WIAt?CrrAfi-,W)V( Ea:(AJU 113RAKE I.AYI IF 94MANI V) l <br /> w <br /> z 2. <br /> w <br /> f7 <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information <br /> ENIERt3ENCY CONTACY GMEMtT FC I AM424:)3(X)NAJ R(;4 a;3 f f/1 TM VROFJLt:A�jfi)I (?)Jfl 1 BHAKJ: i.Al}IE SNAdstN(;:: <br /> 'K4A1t0t4(j771 'APPROPRIATER[R (N4PROTECTIVf..H]UIPWNT <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 labeledlplacarded,and are in all respects m 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 sandy that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Genereloesr0(feror's Pdntedrryped Name Signature Month Day year <br /> J 16.International Shipments <br /> ❑Impact to U.S. ❑Export from U.S. Port of enbylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> a ,r <br /> n <br /> Transposer 2 Pdnryped Name Signature Month Day Year <br /> K <br /> H <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space Ouantity ❑Type Rai❑ ❑Residue Partial g ❑Full Rejection <br /> f ManHesl Reference Number: <br /> F 1Bb.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> tai FaclliVs Phone: <br /> W 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> a <br /> 2 <br /> h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 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 /> 1 PnntWyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />