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Of <br /> Please pint or type(Form deal red for use on elite(12-pitchy type writer.) rp,: II II III I VIII I II I Iul "� Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 7 Generator ID Number 2.Page 1 of 3,Emergency Response Phone 4.Manliest Tracking Number - <br /> WASTEMANIFESTerr,/j i'A A A6 <VA•i., 5 li 007245157 FLE <br /> 5.Generators Name and Mailing Address 7d a A 1 Generators Site Address(if different than mailing address)' <br /> r ,ia a`l't lr* <br /> r.. ,1r UITF Iiyddaway <br /> ?31 r) Rrf <br /> Generator's PMne-+ •0d r'}BT'1 to <br /> 6.:Transporter t Company Name Y U.S.EPAID Number <br /> ,.r t:r1;'rr'<*} ,.Cn•`Lz lt, totD._i,;.' F �u.t'Ynp, n, <br /> 7 Transporter ZCompmy Name U.S.EPA ID Number - <br /> y <br /> Y` <br /> 8.Designated Facility Name and Site Address ri 1 l: r dSe.y, iIng ;^V5 ,q„ wrl U.S.EPA IDNumber - <br /> AW W. "onto Avenue <br /> Rialto. CA. 32316 <br /> Factilrys Phone: g(C 421_2012 Ext I.t{[J�13t2 <br /> ga. 9b U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total+ 12.Unit 13,Waste Codes <br /> HM and Packing Gmup(deny)) No. Type Quantity WUVDI. <br /> lad 1 On KRA, ha2:ardi Waate, aClid f Paint) i sl <br /> � YAA 15o 15'0 <br /> Z 2. <br /> N <br /> 3 <br /> N V 1 2014 <br /> 4. <br /> E VIRO, _ <br /> 14.Special Handling.Instructions,and Additional Information 1..141372319;U1Xf.10 1 1A2_ V <br /> One or more of the materat listed on this rnanitest may <br /> FRI323-026t}109 2 1pta5 i 111 be recycled as alters,,,aaative daily cover(ADC),or other <br /> method which uses r It I I.in Q�o dhe land <br /> 1T ; � \, <br /> 15. GENERATOR'SfOFFERORS 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 Iabeledrplacarded,and are in all respects in proper condition for transport according to applicable international and national governments!regulations,if export shipment and I am the Primary <br /> Expode(I certify that the contents of this consignment conform to the terms of the Attached EPAAcknowfedgment of Consent - <br /> I certify Net the waste minimizalion statement Identified in 40 CFR 20:000 16 9a�ittt juerclgghery,(or)or(b}(If l am A small quantity generator)is me. <br /> anemtor rocs frimi IYPW Name . Signature �t .t Month Day it <br /> u 16.International Shipments �l-^-^'tt ,r <br /> ❑Import to U.S. U;ExAdnfr'om U.S. ,Pat of enp8(exN, <br /> z <br /> Transporter signature for exports oil -date lest in 'U.S.r'Op 17.17.Transporter Acknowledgment of Receipt of Materials <br /> Id Id Trams�'o(It 1�PH Wall ed NaTe ( .h( ignalu \�,(y j p on ay (ear <br /> 2 cY/�. �'� \ <br /> z Transpoila2Pnnted yped Name Signs ure � on sy ear <br /> 1 j 1 <br /> , <br /> t18.Discrepancy <br /> 18a.Discrepancy Indication Space [I Quantity [IT allG Partial Rejection ❑Full Rejection <br /> FLM 0yC SERVICE �O EACNIT'f P <br /> 186 Alternate FaGhty(a Generator) .S.EPA ID Number <br /> A*WU ACCEPTTHSWASIE AS SffK <br /> LL Padli 's Phone. <br /> Ric.Signature ofAltemate Facility(or Generator( Monty Day Year <br /> a <br /> N19.Hazardous Waste Report Management Method Godes.8.e.,codes for hazardous waste treatment,disposal,and regdieg systems) <br /> 20.Designated Faculty Omer <br /> roorr Operator:Cerificatlon Of re selah �plFof hezamous ateriais covered by Ne mashie t e pt As noted in Rel <br /> i8a <br /> PnntedrTyped Name ( ' 1 Sig i c y h Ye <br /> 4N <br /> ::AMA . 1 <br /> EPA Form 8700-22(Rev.3-05) Previouseditlons are obsolete. DESIGNATED FACILITY TO GENERAT R <br /> 8'7(Ni-a^ Col 15v3 CRI68449 S03� 3/9384 H116009 PD073014, __ 0._..... __:__ <br />