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Please print or type.(�Iorm'designed for use on este(12-pitch)typewriter.) i Form Approved.OMB No.2050-0039 t <br /> UNIFORM HAZARDOUS 1 Gem ID Number ✓ 2.Page f of 3.Emergency Response Ptlone 4.Manifest Trackfn Number <br /> WASTE MANIFEST - 7��`1 9a - too 7 FLE <br /> 5.Generators Name and Mailing Address than malting address) <br /> 8P firIA- t Coad Pt &ds. LLC A tj tr tt{{ <br /> P-0.Box 80240 <br /> Ran:.:;to Sarta klalrprtta.CA 9 `! (&C1 0 <br /> Generators Phone. usl a r- lorry -r :,. x <br /> 6.Transporterl Company taAmte�y {e::, a yy',,�*. ti US:FFA IDNumbersr� <br /> EVEL�wHi!r�'a L� <br /> 7.Trans { U. .EPA I Number / <br /> 1A Dim <br /> 8.Designated acifiry e a .,i e A ress ` ' „ " ' U.S.EPA ID Numft <br /> NMemo 4 a-rdoO- <br /> 22 <br /> Faciti 'a' <br /> F �...�.. .. - :.•�Ul •u it 7,#:CU 3idti.+va{tf <br /> 9a. 9b.U.S.DOT Description(nduifing Proper SN Reme,Hpzard,6( s fD Numl>Br Ag,.Er�a �4£Antal9erS „e t$eTOl�l ,1�_itrHt „ .iNeste Codes <br /> HM and <br /> 4Pecking <br /> }�(L0916*any)) No. Type Quantity WuVol. <br /> 'r lSft.^'._. d,Nt_ �`.1t4. r nr r<76 fk: <br /> IX <br /> I <br /> W 2. <br /> L <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additiona;Information V4EAR ALL L: <br /> PERSONAL PROTEE'TWiL <br /> 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION:(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 labeledlp(acarded,and are in an respects in proper condition for transood 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 terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(if l am a small quantity generator)is:rile. <br /> neratots/Offerors Printed/Typed ame SignatureMonth a Y ear <br /> m• ��- <br /> -r 16.international Shipments <br /> F.. ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Z Transporter signature for exports only): Date leaying U.S.: <br /> w 17.Transporter Acknow edi of Receipt of Materials <br /> Transporter 1 PrintedTyped Name f Signature ; �'. FI.ntn Uav Year <br /> Z Transporter2P4&Wdll'ypedNai Mon Day Ye <br /> 16.Discrepancy <br /> 1Ba.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Ful Rejecticn <br /> Manifest Reference Number. <br /> r <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> v <br /> Q <br /> �- Facili 's Ptrone: <br /> W 18c.Signature ofA lemate Facility(or Generator) Morth Day Year <br /> 1 F— <br /> CD <br /> 19.Ha=ous'Naste Report Management Method Codes(i.e.,codes for hazardous waste treatment,dispesaf•and recycling systems) <br /> UJ 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Cerfigr,ation of receipt of hazardous materials covered by the manliest except as noted it Item 18e <br /> PrintedlTyped Name Signature Mont: .Day <br /> EPA Form 8700-22(Rev.3.05) Previous itions are obsolete. :: ` TRANSPORTER'S COPY <br />