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--i__•.._..1_i-_w��w_w �.ww..u.'1 _-___4ww_..•.....>- --..J .•_._______ ._-. ._______._._.�-__ww...v_��.••._ .-_� ..a.� _ �__. -�.'..�.�._. - t_w�ww_wew'�.. �. �`.`„ Please pnriior' .(f'brm designed for use on elite(12-pitch)typewriter.) Form,Approved.OMB Na 2050-0039 UNIFORM HAZARDOUS 11..�Gpnerat.,ID Number 2.Page 1 o` 3.Emergency Response Pnore 4.Idanifest Tracking Number WASTE MANIFEST �. i i x(}1 x r,CF < `. b f. J J K 5.Generator's Name and Mailing Address. Generator's Site Address(If different than mail ng address) v95 S .IRPOR I WAY �jtJ�G i 5a5?>� 1t7S°3 CA'. 915201 JCCfZ*:T0N Generators Phone: IMS 411� A-21 6.Transporter 1 Company Name U.S.EPA ID Number SRi„r' SUOVKX5t 7.Transporter 2 CornpanyName - U.S.EPA ID Number 8.Designated Facility Name and Site Address ( U.S.EPA ID Number bV` A31tA'�49tht'E it: F'i<6v'r.3L G�,f 53 71 SOLI H BUYLt.03 A140ELES -,350 Faci lty's Phone:, r«. n—•, 4 r4,-t �r �1 r',ZYFk2A .'•'k ga 9b.U.S.DOT Desalption(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 3.Waste Codes HM and Packing Group(if any)) No. Type Ouan5ry W:.NoI. l OQ k f =:�..t`4 Y¢-..^xY L-lrvlk-RDOUS WASTE.S6913D.ffQ11 tJ'''lUDS - 2 2. Uj 77 3: E L 4. 4_ y 14.Specel•Hariding Instructions,anC Add'tional Information r� irl `I : I / Ft,RFft F6+46�1P':.Cyc4cTkf T; :=F €i 1 3.,�aL'ce ,)v Thr° ,;5?�i zCl�(t 1; ?'175?1A�.ki1 Y SOLOS PON x`:PPi OPIiAT� MRSoliAf, 15. GENERATOR'SiOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fuJy and accurately des&bed abov&by the proper shipping name,and are classMed,packaged, ' marked and labeledlplacarded,and are In all respects In proper condition for transport.according to applicable irrtematJoral and national governmental reculalions.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to,he terms of the attached EPAAckrmiedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a'.arge quantity gererator)or(b)(if am a small cuan*generator)is true. GaneratoeslOfferors Printedffyped Name Signature, Month Day Year _+ 16.International Shipments u ❑;mpdRto U.S. ❑Export from U.S. of entrylex t Transporter signature(for exports only): Date leaving U.S. W 17.Transporter AckrwxledgmeM of Receipt of Materials TransporX Pdnted/Typea Nkrrn l Signature Morrdr Day Year 0ad- Za-Transporter 2 PdntMfrypad acne ' `S re r Month Day Year 1 B.Discrepancy 18a.Discrepancy Indlcallon Space Ouanto Type ❑Residue Partial Rejectian Full Reje,^t.cn Manifest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number 0 Facillty's Phone: 'Be. - 11 Signature of Alternate Facility(dr Generator) Momh Day Year ju S219.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and ecyding systems) G 1. 2, 3. 4. ✓ J 41 �t 20.Designated Facility Caner or Operator:Certification of receipt of hazyrdocs materials 9overed by the man'dest except as noted in Item 18a Printedlryped Name 9 / �� 'nature r % Month Day ear i ]'.•f•p�T Sii•'/ t ` t ^ y, /i� �i(.r� — /t r �n EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENER';1T68'STATE CAEQUlFfED)