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Please print or ty a (Form designed for use on elite(12-pitch)typewriter.) -orm Approved.OMB No.2050-0035 <br /> UNIFORM HAZARDOUS 1.,Generafor ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number s <br /> 4 }4.24-mo n'I 3.� J J K <br /> WASTE MANIFEST t l.f� �l Ft iri z i .C- :� <br /> 5.Generator's Name and Mair) Address Generator's Site Address fif different than mailing address) <br /> P'0'. it�kv,;ST 0 IV-KT 01 IN i4'14 �qq C oft's 4 FC?frt T° 34` t f €° f��tlfi WO ON <br /> 4 <br /> CA <br /> Generators Phone: 2V9 465-3,421 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> AWay. � `� �� � <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.DeRIJAWATER <br /> FacilityName and Site Address U.S.EPA ID Number <br /> TEG'HNOLOGJEC L'.; <br /> SOUTH BOYLE XVENUIE <br /> LOS AJ4GELEi CA 7Ca-05E! <br /> Facility's Phone: (322)2T7-1500 7-.2.50`1 e A Q O ? c s <br /> ga_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Kumber,' 10.Containers 11,Total 12.Unit <br /> HM aid Packing Group;`any)) No. Type Quantity WtIvol. 3.Waste Cotes, <br /> 1'F„iR 61 nrti•^r' G'�r9r�i«•r.pr;,t-1-11: s EN `r�Si'v"�:[f'.'bC4• zC t - <br /> � i,::rtrst��^ U4. r,:..�=�•_�J. `c � ..%�:tt <br /> Z 2. / <br /> Lin <br /> -xm-CEIVP3 <br /> FEB'1 7 2016 <br /> 4. <br /> E NMENT- P L <br /> H .ITN nNPPARTVCNI-r <br /> 14.Special Handling',nstn.ctions and Additional Information <br /> FMERGENC'r-CONTACT: CHEMTREC 1-90£!-bf242300 KAERG4 931:171 Y ?i10PLE e4�9B1:AP 1.7 5!64 0 L <br /> SOUDS .f,C AiI0195242' F41 1`! 0TE- 0 .'6 <br /> ROTSC 'EQ? t, r <br /> t <br /> �•'�j^��. JTZ.. ,�t�''G/7 x S•� u !!fit_. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare[hat the contents of tin s cons!'Jnment are fully and axurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacareed,and are in all respects in proper condtion for transport according to appCcabie in;ematlonal and national govemnental regulations.If export,shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms o'the attached EPAAcknowledgment of Consent <br /> Icertify that the waste minimization statement identified it 40 CFR 262.27W(if I am a large quantity gene:-ator)or(b)(if'.am a small S} ntity generator)is:rue. <br /> Gene' 'Offerors PnntedlTyped Narne,'\ Month Day Year <br /> 16.Intemational Shl&egts L) <br /> Z F Impart,to U.S. G Expo-t irc-n U S. `Tori bf entry!ezit <br /> Transporter signature(for exports only): Date leavuig U.S.: ! <br /> W 17.Transpo•terAcknowledgment ofReceipt ofMatena!s j <br /> Transpo r 1 NntedRypad Na Signature �/ Month Day Year <br /> ZZ Transporter 2 Printedrfyped Name ' 1g-ature - Month Day Year <br /> r <br /> 8.Discrepa-cy <br /> 18a.Discrepancy Indication Space Quantity n Type nn <br /> L_Residue �?artial Reiecton ❑Full Reiection <br /> b'an'fest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Numoer <br /> U <br /> Pao lity1s Phone: <br /> w 18:.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes'or haza•dous waste reatment,dsposa[and recycl`.rg systems) <br /> G 2. 3. 4. <br /> 4 20.Designated Fac lity Owner or Operator:Certification of receipt of haza dons Hat ials�veree py the ranifest except,as naec in item 18a <br /> Pnnted/Typed Name Sgoature �f / f%/ j Month Day Year <br /> �.PA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br />