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Jul 16 10 01:24p p.2 <br /> Please Rlint or type.(Form designed for use on elite(12-Pilch)typewriter.) Form Approved.0MI3 No.2050-0039 <br /> UNIFORM HAZARDOUS r t 1ie ator ID Number 2.Page t o1 3.Emergertcy Response Fftcne 4.Mlanifest Tracking Number <br /> WASTE MANIFEST f 8a� � 1 1-800-424-9300 <br /> 003336083 JJ K <br /> 5.Generator's'dameandMailingAddress :' r L� 4Vt Genera�sSiteAderess(if differentthan rnai.ingaddress) <br /> 7� T i � .- q s3o tf <br /> g"-znsU.S.EPA ID Number <br /> 66Wd4ftnvironmentai Services CAD982413262 <br /> 7.Transporter Z Company Name U.S.EPA 10 Number <br /> a.DesignafedFadlityName 2nd Site Addres vergreeft C 11, 1 1l C_ U.S.EPAIDNumher <br /> 6880 Smith Ave. <br /> Newark,CA 94560 CAD980887418 <br /> Facilitys Phorts- 510-795-4400 <br /> 9a. 9b.U.S.DOT Desc plion(including Proper Shipping Name,Hazard Class,ID Number, 1C.Containers 11.Total 12.Unit 13.'Ptaste Codes <br /> HM and Packing Group(if ary)) No. Type Quantity WL'VCI, <br /> 0 <br /> LLI <br /> 7- <br /> 3- <br /> 4. <br /> 3a. <br /> i <br /> 14.Special Hand.'ng instrutars a-d Add&nal Information <br /> 15. GENERATOR'&OFFEROR'S CERTIFICATION; I hereby declare that the cvrrlents of Sts consignment are fully and accurately described above by the proper s ippLng name,arta are dassrfied,packaged, <br /> marked and Labeledrptacarded,aM are is all respen in proper condition for transport accoremg b applicable intematienakand national grne nrreMat regulations.if expo-t shipment and I am the Primary <br /> Exporter,l oertity that the wruents of this consignment ccr?orm to the terns of he atta&.ed EPAAcknowledgment of Consent. <br /> certify that the waste mininintion slalement identified io 40 CFR 262.27(x)(d I am a large quantity generator)cr(b)(if i am a small gwmity gerrerator)is hue. <br /> GaneiaW!&j ercdsPrinledfTypedNam ;e , Signature' hlonh Day Year <br /> y r� Y72t cam-, � — 1 lc, <br /> �.�n �' {Z <br /> lnlematioral <br /> Z— a.l men's i - I1��1 <br /> Expot fom U.S.` Pwi of eylexiL❑on DrttoU.S. <br /> Transporter ssnaiore(cr axpCrts rn:y): Data leaving US <br /> .: <br /> X 17.TmssporterAdtnarlegmsl of Rec--;%xf VaIRn2ls ? <br /> Transporler 1 Pnntecl�ype e /l�� SigrrGre �✓�` / month Day Year <br /> N Month YaY fear <br /> z Transporter 2 d)Typed Name SignaWre <br /> a <br /> a <br /> 18.Discrepanry <br /> 18a.Discrepancy Ind-cation Space Quantit.y ❑Type ❑Residue ❑Partial Rejection ❑Full PZ jectivn <br /> Manifest Reference Number <br /> 1 Bb.Nlernate Facility(or Generwor) U.S.EPA{D Number <br /> U <br /> rat Fadly'sPhone: <br /> onth Day Year <br /> Lu 18c.Srgrahue of Ntemate Faciity;or Generdb;) M <br /> Q <br /> z <br /> 19.fiazard•xrs Waste Report Management Method Codes(Le-,codes for hazerdotu wraste t eatmenL d'sposaI,and recycling systems) <br /> LU 1. 2• 3. 4. <br /> 20.Designatad Facility Owner or Cperator.Certificatirn of rewipt of hazardous mater"afs covered by the manifest except as nded in Iters t 9a <br /> PrntediTyped Name S g rattz a Monrh Day Year <br /> EPA Form 8700-22(Rev.n5) Previous edltiorrs are obsolete. - ' - <br />