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Please print or type. Forth Approved.OMB No.2050-0039 I'dT ID�xnb� 2.Page 1 of 3.Emergency Response Phone 4.Mantfest Tracktn Number UNIFORM HAZARDOUSY l! ll O � 2 7 9 2 6 � 012�6`4964 FLE WASTE MANIFEST (8Aa) 41 WASTE 5.Generator's Name and Mailing Address �neratofs Slte�e ss(' different an mailing Col�tco Tdlialat�+a141r Corprsrstion oSltc0 Wl7O�elCfil�le - K'F't1X�i - QOS6 PCS Box 912�988 1616 East Harlmer Lane Rancho Santa Margarita, CR 9j�88 X60-"Z0i7 Stockton, Cin 5 210 Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number Fi&L8I•iII� �A.�.Q CID 2 8 3 9 � � 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number U-9. Ecology Narvrltde ooerations H V T 3 3 0 0 ! 0 0 0 0 gighway 05-, 1; miles K of Beatty eatty, Faality'sPhune. {77ffi) $S 220 9a. 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 WtNol. 1. UM179, biaute Solid* (Containing Flammable 8 382 P-015 p X Liquid, to-c_s-, 4.1, RG II (Contains +r Gasoline) bill Z 2. w ra 3. 4. 14.Special Handling Instructions and Additional Information WEO All WRt)YRUTE F.RG#_ In PROTECTIVE CLOTHING B SI � �3�el l "Worbent, Pilrill Aebri■ Caat,anstnated COSTC7 ll813SBt33 with Gasoline i Bf1OP'ILE. Y► t)�i'-•�.I.i-'�'.t��."'�.7�� 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this copsignment are fully and acauately described above by the proper shipping name,and are classified,packaged, marked and labeledoacarded,and are in all respects in proper condition for transport according W applicable intermationaland national governmental regulations.If export shipment and I am the Pnmary Ero porter,I certify that the contents of this consignment conform to the terns of the attached EP Acknowledgment of Consent. I certly that the waste minimization statement Identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)('tl am a sr"l quantity generator)is true. Generatoesl0ifees PrintedlTyped Name Signature ; Month Day Year Lawry`ftothairt of DEBI on behalf of generator 16,IMemational Shipments ❑Import to U.S. Export from U.S. Port of enWexit ? Transporter signature(for exports only): Date leaving U.S.: Ir 17.TransporterAdmowledgment of Receipt of Materials Transporter l Prinied/Typed N Slgnalure Month Day Year a Z Transporter 2 Printed Typed Name Signature MonthDay Year 18.Discrepancy IBe.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Aftemate Facility(or Generator) U.S.EPA ID Number J U U- Facility's Phone: w 18c.SignatureofAltemateFadlity(orGenerator) Month Day Year 19.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 Pdn ypLd Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY