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Int or a (Form des! ned for use on elite (12 -pitch) typewriter.) <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-0 Previous editions are obsole . DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />V. tyP 9 <br />I <br />UNIFORM <br />1. Generator ID Number <br />�A �°°po 3 �R b 3 <br />2. Page 1 of <br />3. Emergency Response Phone <br />134 <br />4. Manifest Tracking Number <br />0 0 9 812 9 5 3 J J K <br />WASTE MANIFEST <br />x <br />� <br />Na cis s►n � <br />-5. Generators Name and ailin Address Generator's Site Address (if different than mailing address) <br />t ly)� S'To kTON METROpouTAO AIRPORT <br />!'L K1� (7 SOc7o A� rp°G 5 b�l <br />�= Z <br />91 ' I.a-1 1, ry CA <br />Generators Phone: <br />6. Transporter 1 Company Name U.S, EPA ID Number <br />NR( vI-V rov, CAR 00000 <br />7.Transporter � eny Name �� r U.S. EPA ID Number <br />C Z3 CS <br />8. Designated Facility Name d Site ddress U.S. EPA ID Number <br />�rPb3o�I 14-k sk <br />18ea 1 . 90813 CAD Co ;4 0 t <br />'2" <br />FaLoll <br />cility's Phone: s <br />9a. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID.Number, <br />10, Containers <br />11, Total <br />Quantity <br />12. Unit <br />Wtivol. <br />13. Waste Codes <br />HM <br />and Packing Group (If any)) <br />No. <br />Type <br />1OH - k12A Rainy& t s WAW, X15 u 0 <br />33 <br />0 <br />�� <br />004- <br />DM <br />, D <br />G <br />Z <br />2. j�f�- f�ccRA }ia7 rdws S+e r -6-01i <br />26 <br />C� tarp s , -ht+ ce 1, ci• U Ca+' �, s <br />oQ 1 <br />D )w <br />I <br />3. <br />4. <br />14. ial Handling Instructions and Information <br />�,, pro�rtr (��.' ppb f P° �' 7�G � dg --V3 <br />Vi- (/ <br />t,R CES 1605 Tiyvj Pik, Awa , (IN 9 4501 <br />q g1) %"L 57 l xsS <br />15. GEN ERATOR'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, <br />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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, <br />I certify that the waste minimization statement identified In 40 CFR 262,27(a) (If I am a large quantity g small quantity generator) s true. <br />Generator rs PrintedlTyped Na,�e/ S gnature Month Day Year <br />13 <br />. + <br />F <br />16. International Shipments <br />❑Import to U.S. ❑Export from U.S. Port of en lexit: <br />z <br />Transporter signature (for exports only): Date leaving U.S.:, <br />W <br />17, Transporter Acknowledgment of Receipt of Materials <br />Signature Month Day Year <br />Transporter 1 Printed/Typed Name <br />0 3a I <br />oCMonth <br />ZZ <br />Da Year <br />Transporter 2 Printed/Typed Name Signature y <br />25 1 O <br />16. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />L) <br />I <br />LO <br />Facility's Phone: <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />Q <br />Z <br />N19. <br />Hazardous Waste Report Management Method Codes (i.e.. codes for hazardous waste treatment, disposal, and recycling systems) <br />W1' <br />0 <br />/�' 2. \ 3. 4. <br />1 V Jl <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materi Is covered by the manifest except as noted In Item 16a <br />th Ye <br />Printed(ryped Name t5ignalure <br />EPA Form 8700-22 (Rev. 3-0 Previous editions are obsole . DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />