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y, IVED OCT 2 9 .C�7 Please print or type.(Form designed for use on elite(12-pitch)typdwrtter.) Form Approved.OMB No.2050 0039 I'.Generator ID Number g y pone Phone 4.Manifest Tracking Number i�UNIFORM,HAZARIDOUSl 2.Pae 1 of 3.Emer enc Res ASTE MANIFEST f "' '� 9 f�„tt ;�idO 03?.:f f ^39 JJK -nerators Name and Mailing Address Generator's Site Address(if different than mailing address) .'.1 F..ALMONC)WOOD f)R Et.9t TC—C.A. .."A .953:37 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number ;i Fi(i4-•ISA. �i}.J�1�r v�,)Lt1TJ(11`t�; I C rIUQQQ13c16491 7.Transporter 2 Company Name U.S.EPA ID Number I r i 8. esr paled Facility Name and Site Address U.S.EPA ID Number ) �_9EWRANCHO(•URDO`,!A,LL'-'-. 119551 1 1955 WH.T E RUCK RD. :,AC98088<S18 RANCH()t.'_IQR:'.[)CIVA,CA 9`i7t'•.; i Facility's Phone: t ga. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit I HM and Packing Group(if any)) No. Type Quantity Wl.Nol. 13.Waste Codes 1. f40t i-RCRA HAMPDOUS WASTE`301, ? r'IR 345 P o `0F f:«�[�EIJT , L 2�3 35? I 0 �---- 2 I ; I I 3 i_ t . .„,I �arill �Cont ( I I perintlits IVI , of IU YY I(1 v ent N Ir r i the waqtp this nerator is -' 4. shipping. - I 14.Special Handling Instructions and Additional Information I RvFiCF#R 2,C.) APPROPRIATE PP,-6r7,-%,,F CLOTH Wi SEE EPG Al 71 I 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, I 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 Exporter,I certify that the contents of this consignment conform to the terns of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantitygenerator)or(b)(if I am a small quantity generator)is true. GeneratoY90ffb'idi"s'•Prmtedfq "d't4'ame Signature Month Day Year i 2.. AQ 12 1 o -J 16.Inteinational Shipments ZImport to U.S. ❑Export from U.S. Port of entry/exi: Transporter signature(for exports only): Dale leaving U.S.: l u�r 17.Transporter Acknowledgment ofReceipt of Materials Transpo ted/Typed Na [e O D Sign t i} Mo h D Year j QTrans iter 2 Prin ed ame Si nature Month Day Year I F- I 18.Discrepancy i 18a.Discrepancy Indication SpaceEl Quantity ❑Type ❑Residue ❑Partial Rejection ❑full Rejection Manifest Reference Number. i a- 18b.Altemale Facility(or Generator) U.S.EPA ID Number J i FP19.Hazardous il 's Phone: ,Ujgnature of Alternate Facility(or Generator) Month- Day Year Waste Report Management Method Cedes(i.e.,codes for hazardous v:aste treatment,disposal,and reycling systems) 1 f 2• 3, 4, i ,ignated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Typed Name Signature r i r Month /Da Yra 'A Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR -- --- -- — _..- -.J