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Please print or type. (Form designed for use on elite (12-pittypewriter.) PMII (I II II I I "I�"I II I I II I II Form Approved. OM No. 2050-0039 8796 "a?--ca1 15v3 G1i166449 S03F t+79354 M.1.16009 UNIFORM HAZARDOUS + Generator ID Number 2. Page i of 3 Emergency Response Phone 4. Manifest Tracking Number EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete. 7:'7"014 SD a % h e DESIGNATED FACILITY TO GENERAT.. R WASTE MANIFEST M1,!'fSi1 s t --'xh it 007245 FLE 5. Generators Name and mailing Address etta1-Ja$11P }i'61111af1 Generators SreAddress (ff different than mailing address) ,R" Inc, Ltf a, YK Fre1t>ht I F.T(ed38way ." 91,1-344-.'Uyr WWO K-,L-.tAvi, T""I 1'3fx11? Rd - Generators Phone? r.✓veringll 0`i V11 I 6: Transporter 1 Company Name US EPAID Number •Y.ar'1r•'jt!.1 ty ' .C'ka:ltrr wilAp .rout IDII P,., I n:" 7. Transporter 2Company Name U.S. EPA ID Number 8. Designated Facility Name ono Site Address �'� 1rr:y. dwCYI111aI3, `Y`Pt'iC28 r 1nC, U.S. EPA ID Number. 160 W. Notate !avenue Pialto. CA 92318 Facillbs Phoria: 19(C T_1-2012 EXt- t7A1J{K444 6 9a, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11, Total 12. Unit '. 13. Waste Codes No. Type HM and Packing Group (if any)) - Quantity WtNol. on WRA tla ardotta waste, mlid i hint) 101 Till, M r5'0 P z 2. W RECEIVEL MAR 17 2015 4. ENVIRONMENTAL '(JC(t'TV ^CDs �T�1t-a1T 14. Special Handley Instructions and Additional Information 1•,1r }'7231�a u'� ./i) (Az.— -. � . P One or more of the-ma,timai !rated on this manifest may PR0#323-02.60193 { W BMI be recycled as aftergqallve dairy cover (ADC), or other es the terlal In gu�hsse land , job 11imethod which usana 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 labeledrplacarded, and are In all respects in proper condition for Vanspon according to applicable Inlemalional and national governmental regulators. Itexport shipment and I am the Primary Expense, I partly that the contents of this consignment mnfdre to the terms offbe attached EPA Acknowledgment of Consent I cedy that the waste minimization statement Identified in 40 CFR 204:27(zl1� mi8ai quantlyGenerall or (b}(if I i m a srpall quantity generator) is this, enerator DHeror's note YPea Name tbarium, um -' Mon ay YearC•, tzni<.s rr� .,a, s.:_.. -a 16. Intematonal Shipments EI to U.S. - 1'-�t f,-_IiGporEfiom U. S. Pon of en?Y/eatt>, Z Trans iter si nature for exports only): - Date leaVing US,i W 17, TmnsponerAcknowledgment of Re llpt of Materials - •� f" O oner 1 Pnn y ed NaTe Igna - on ay Year Trans^oar ` N Transporter 2 Pr-intiName ignature A Mon ay ear - ''''`� r t• 18. Discrepancy 18a. Discrepancy Indtwhon Space - �yR j ❑ Full Re' ❑ °ea°d" FLT�R SERVICEMy0 Fly Pamal Rejection a tion RC{��CIM� 18b Animate Faclllty(or Generator) I I it. he I S. EPA ID Number J a ANDWIII ACCEPT TO WASR AS SHIPPED LL Facilil 's Phone: w 18c. Signature ofAllemate really (or Generator) Month - Day Year Q Z LD 19. Hazardous Waste Report Management Method Godes (i.e„ codes for hazardous waste treatment, disposal, and recycling systems) 1 1 2. 3. - 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous atedes mi the man ife e as as noted in Ite 1 a Pi Pnntedlfyped Name ^ t,.� i m .Sig EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete. 7:'7"014 SD a % h e DESIGNATED FACILITY TO GENERAT.. R