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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 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone T4.Manifest Tracking Number JJK WASTE MANIFEST 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) Generators Phone' ........RIXEIVEE', 6.Transporter 1 Company Name U.SEPA ID Number 7.Transporter 2 Company Name dUN 19 U.S.EPA ID Number 8.D i na ed F ci_lity Nar ,an,,d,S e d ress U. P ID N er �f tta i3'v I I,4FA'Tu nC0A0-reACnlT . 1630 W. 17TH ST--LONG BEACK CA 9W1%1XI ) S Facility's Phone: A t 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes Z 2. W (9 3. 4. 14.Special Handling Instructions and Additional Information 98.1 --UM A PPROPMTE PPE WL# : Edi*126 APPROVAL 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 I am a small quantity generator)is true. Generators/Offerors Printed/Typed Name Signature Month Day Year J 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: IX 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Namei Signature Month Day Year O %f CL QTransporter 2 Printed/Typed Name -' Signature ' Month Day -Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number J v LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY