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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking_Number l WASTE MANIFEST 9 J K� JJKA 5.Generator's Name and Mailing Address 001-3'T Generators Site Address(if different than mailing addre EFV E cis, - cis 2,Q JUL 31 2J' 15Generator's Phone: - - 6.Transporter 1 Company Name U.S.EPA ID Number _ EWRONMENTAIL HEALTH i,e":L {ams f f,.,.4..::,...s,,, '`i�.:• 7.Transporter 2 Company Name U.S.EPA ID NumbPERMITIS ERVICES 8.Designated Facility Name and Site Address U.S.EPA ID Number CROSBY&OVEATO-;N Vit. ;7�H ST -LONG BEACH,OA X13 ��+.��/n 0 0,��r Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. I Ix NOSE RMA HAZARDOUS WASTE 57- (SPENT A BSORSEIKT} � z 2. w C7 -- NFS). N.D AND ORFD FOR SU SEQ1 ��P.F7ER�CY�WASTE WAS RE p„ TOY.INCOPERATMS.S T11 F.gCE UN i. 3. )IS D&'.qK:�. \ OF TOXICS SS N: CIZ -ER94TTS GRANTED TO TIIF-M BY r !"r"T1IE ENVIRON,tE"TAL PR TUN A(FNi !r!A`i A ANCE w'TIN PROV 1pKS U ;-1E RESOURCE CONSIMVATTON F D R.CoVaY ACT OF i 76 73 ALLEMni R ITN AND STATE ttF.GUTATT NS. CRCSBY OV�TO HA 5 ALL O S BRAE NiDI.0 WA 4. 1'ER A1717S TO A ACCOPL94GLY _--- 14.Special Handling Instructions and Additional Information 9B.1 -USE APPROPRIATE PPF. • t� �� -a PiR&V AL 4 2- 234 f v 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, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if 1 am a small quantity generator)is true. Generatoes/Offeroes Pdnted/Typed Name SignatureMonth Day Year ,� -J 116.international Shipments p_ ❑Import to U.S. ❑Export from U.S. Port of entrylextt: Z Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAdwowledgment of Receipt of Materials T"orter 1 Printed/Typed Name Silature s MpBfh Da Year O / - '(fie+.' W Transporter 2 Phnted/Typeld Name $gn Month Day Year ' �I.f � 1.�.'I 1 t.R M 18.Discrepancy 1. 18a.Discrepancy Indication Space 0 Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V U- Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) t�11 1. 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as fled in Item 18a PrintedlTyped Nart� i Signatures 1f Month Day Year r , EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR