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Please pent or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone () 4.Mast Tracking Number <br /> WASTE MANIFEST SAD%- 251028., t 91.6-928-045Manifest <br /> JJK <br /> 5.Generator's Name and Mailing Address Generators Site Address('d different than mailing address) <br /> SAN iJA A NV1ENUC- <br /> STGOCTON , C.A. 95'.03 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA 10 Number <br /> T.;d (L-sDLIrC9 ?, slvircnsrenai xn_, tiA39$24.33575 <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 /> ct�:�,:ii1 Resource 3 crrnron;uental <br /> :18.1' ;;n;1--ad Strut rAd3a131402522 <br /> 'N10"aVe.. QA 93901 (C,61)- 524-2415 <br /> Facility's one: <br /> ga 9b.U.S.DOT Description(including Pmper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity WtN01. 13.Waste Codes <br /> ?L�4:' ma-2a_-ElC4is was re, SO l V.10,SC":Y iver r(= CiL011 541 <br /> o 4_0 n?c1ar.ja- ion t]i'7'C. C4n?.r37o ing silver residu= <br /> w <br /> Z 2 <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> b7� }roper erty:-ment,(gloves a, gaggles) um- ERc, <br /> Tr atrie.ttt S{ancdard.- 22 CCR 6626W <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 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 <br /> Exporter,I certify that the contents of this consignment conform to the lenns of the attached EPA Acknowledgment of Consent <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(8I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneratceslOfferoes Printed/yped Name Signature Menth Day Year <br /> 16.International Shipments <br /> Z ❑import to U.S. ❑Export from U.S. Port of enhy/exit <br /> Transporter signature(for exports only): Date lea U.S.: <br /> w17.Transporter Actawwledgment of Receipt of Materials _ <br /> W Transporter 1 Printed7Typed Name Signature J Mmilh Day Yea <br /> CL WAOW� 610101 117 <br /> Z Transporter 2 PrintekllTyped Name Sigrghxe ! Monteh Day Ye <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Owntity ❑Type ❑Residue ❑Partial Rejection ❑Full RWcbon <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA 10 Number <br /> J <br /> U <br /> LL Facility's Phan: <br /> w 18c.Signab"of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> _ _ <br /> 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as in Bern 18e <br /> P'nted/T17 -777- <br /> tuna I, j ,'A. <br /> EPA Form 8700-22(Rev.3-05) Previous edi, are I�solete. { /J ESIGNATED FACILITY TO;GENERATOR <br /> I , <br />