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Please print or ty Vie.`Form designed for use on elite(12-pitch)typewriter) Form Approved.OMS No,2050-0035 UNIFORM HAZARDOUS 1.:Generator ID Number 2.Page 1 of 3.Emergency Response Phone - 4.W rufest TrackingNumb WASTE MANIFEST Cf F_6f r'i';r _ co . S 2 ( fry 4.244-9300 01"13,130"93119 JJ K !_ ?-i 5.Generator's Name and MaTr Address Generator's Site Address(if different than mailing address), - PA BOX 14'k7l 101-895 S. AIRPORT WAIVI MONTHLY WO ONL $1,0CKT0N CA 9520 Generator's Phone: 209 465-M21 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Desi nated Facil' Name and Site Address U.S.EPA ID Number ?I�Ci UA%4ATER TECHNOLOGIES L.G SOUTH BOYLE XVENUE LOS ANGELES GA &0-05E 3z3 C�eDO 'Oz tFE? Facilitys Phone: (m)27 7-1500 '. ga_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class)D Number,- 10.Containers 11.Total 12.Unit ff 13.Waste Codes HM and Papkirig Gmup(f any)) No. Type Quantity WtNol. - 1'F.`irt RF LIND p, GA"'e.—r%n Mic., �,,L_yrn='rr, rr'et `E%Fi _ ir"c � 1�2::1Et^-t 6c Lt*Y tii4?J�a:X:_-1.'ee:-J. cCe'�-�:'�L;/_..:L.IS!(•1 Ef�F ,]'Ji-:f/<�£ _ D m ��• l z 2. Lu f.7 4. 14.Special Handling Irstn,ctions and Additional Information 'WERGENCY€`OINT&OT!CPEPSITREC 1-9-GO 24-s CO KAERG 0- :171 PRO RLE 9 981:AP 75764 GELS' SOLIDS F POO-A.i=95242 = APPROMl4.FE,rER 4f E 'rF `m EQ�UP��*eF _ 15,. GENERATOWSIOFFEROR'S CERTIFICATION:I hereby declare that the contents of ih s.conslgnmentare fully and accurately described above by the proper shipping name,and are ciassified,packaged, I' marked and labelediplacarded,and are in all respects in proper condition for transport according to appricabie intemationaland national govemmental regulations.If export shipment and I am the Primary -. Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledpnant of Consent. is I certify that the waste min rrizatlon statement identified in 40 CFR 26227(a)(if I am a large quantitygen.eretor)or(b)(ff i am a small puanfity generator)is true. Gene' IOfferoes Printedrryped Neme Signa- Month Day Year ! % -ne r•-�."- � �'1 i�S1� �4 Lit Cl 6c 16.Intemafional Shlp)fiegtsVj i F- w ❑Import to U.S, ElExport from U.S. �or�iSf entrylexit 2 Transporter signature(for exports only): Date leaving U.S.: LW 17.Transporter Acknowledgment of Receipt of Materials Transpoder 1 Pnnted/Typed Na F Signature Month Day Year i O W Transporter 2 Printed/Typed Name gnahrre Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space riY ❑Partial Re ecfion Full Rejection ❑ Quant' Type El Residua j ❑ J Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Numoer J , U Facility$Phone: y Lu 18e,Signature ofAitemate Facility(or Generator) Month Da Year Q Z S219.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal;and recycling systems) ' A 1, t 1, 2. 3. 4. 20.Designated Facirrty Owner or Operator,Certification of receipt of hazardous mat 'als vered by the manifest except as noted in Item 18a Printed/Typed Name /J % Signature /. Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED)