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Please print or type.(Form designed fer use on elite(12-plich)typewriter.) Form Approved.OMS No:2050-0039 <br /> UNIFORM 11=1130u5 1.Generator rD Number , , a . -,$3ge 1 of 3.Emergency Response Phone 4.MantfeslTracking Number <br /> WASTE MANIFEST C.F A00337276 1 tj0tC 36?-4778 1 008460039 dJr` <br /> 5.Generators Name and Mailing Address Geheraloes Site Address(if different than mailing address) <br /> PACVFlC C T HAM0L 5T0C Y T t'q LL£r�'• — i3 NAVY DF <br /> 3TA fEEAVY OR 4 1 <br /> 5 C>e3C)M ,� C4 5 5TOCiKTON CA 915 yj <br /> Geherafor's Phone: <br /> 6rporter 1 Company Name - _ U.S.EPA 10 Number <br /> E€'trlRONfbENTAL FEC60*i'"WfWk E-r—,IqC. <br /> 7.Tiaasporter2 Company Name U.S.EPA ID Number I i <br /> 8.Designated Facility Name and Site Address U.S.EPA 10 Number <br /> U-9 ECOLOGY <br /> fth"Y 93,1'2 144E7&OUT" <br /> SEATri ✓4A! VN- 3 <br /> FarA ys Phone; { >t 72ryj ;... N VT 3 3 0 G 10 D 0 ' <br /> ga 9b.U.S.06T Dascrtp n(including Proper Shipping Name,Hazard Class,l0 Number, 10.Containers 11.Total Q.Unit =- <br /> 13.Waste Caries <br /> HM and Packing Group(f any)) No. Type Quantity Wtdvol, <br /> 1. -� v r;. A .. -• _ � ik Cit I <br /> W 2. <br /> CORROS E OWD,A CDC,040PGANNDC,t4,0.5.,6,LfhI ,(SU <br /> k <br /> ae F �G, ! <br /> 4. s <br /> TF <br /> 14,Special Handling Instructions and Ptfflcna,I(hfoation <br /> fm_ 1 t E 0 SElt 1�4,9n. i6h.gra 4 u3d to o;#T -ECra k <br /> 9 53 E 7-ACS!L3 1 e rC, �1~ rye x 9 1� bF •ff... ? ,3. _ ' <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents,aJ 'Wconsignment are fully and accurately described above by the proper shipping name,and are classified,packaged.:,�j. ` <br /> marked and labeledfplacarded,and are in all respects In proper condition for transpoR according to applicable intemadonal and national governmental regulations.If expefl shipment avid lam the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgmentof Consant <br /> I caflify that tsa waste minimization statement identified In 40 C,FR 262.27(a){ill am a'large quantity generator)or(b)Ina am all quantity generator)is �6: <br /> GeneralersA)ltefO N PH ntedfTypad Name Signature t Mc D Yga <br /> 7 <br /> 116.internal nal Shipme is ❑ ` <br /> Flaw import to U.S. from U.S. Port aniry,,ezit: <br /> Transporter signature(for exports only): Date leaving.U.S.:-.- y <br /> LW 17.TransporterAdcrrowledgmentgf.ReceiptofMaterials <br /> TranspoV PdntedlTyped N maSignahrrey 1Month Day , Year <br /> Transpolar22Prin ypedName Signature Month ay Year .s <br /> 18.Discrepancy <br /> 18a.DiscrepanciyindicationSpaca ❑ Quantity Type ❑Residuefeceon <br /> F'erdal Re' ,❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) 4' U.S:EPA ID Number <br /> Facililys Phone: , <br /> W 18c.Signature ofAlternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 20.Designated Facllity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in ItemJBa <br /> Printed/Typed Name[ Signaler Mon D Y ar. <br /> EPA Form 8700.22(Rev.3-05) PrevlousediUonsare obsoiete. / TRANSPORTER'S COPY. <br />