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Please print or type.(Form designed for use on elite(12-pitch) -writer.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST I '',-A! )t7tl `t}14. fYfr- ,' 5 C 0247 f�U D p 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) SILIMIDEN"RE WkXXICTS,(-(,1PPF I$1 a EL f4w-4,11-DR t ?0-'KT(-,)N.r=A 9'S'NJA Generator's Phone: f)9-64 9; 6.Transporter 1 Company Name U.S.EPA ID Number A,"ii 5i)t iJT1C�1•I;,INC 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address ., U.S.EPA ID Number 11655 WHTF ROCK RD RAW-140 CO M)VA,CA x+14'?. Facility's Phone: I Zc 1 (t, �.) 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes (-,rci No. Type Quantity Wt.Nol. 1. .'y A�.;rL rNtIT 1?F"'��."E0))AA FEF4. 1. , 3 I.`N I7fi'z.r, '( 1 (}M 1)(13 2 It 30 Z 2. W114-P(,12A .fS WA7c,T-E1 iC tIii + r1a� 40 0 WA f EMbk PANT8 3. 4. 14.Sl Handling Instructions and Additional Information ecia 1-F'f Of-- E ll -`P10?10-11),04 t BAK PAINT E:RQ..012e PROFlt--O"`f"12101-00 WA ER B<FJ LATEX PMNT a E€O,#i;t APPROF'4?f,ATE PROTECTNf CI_OT41NG EMERGEW-'-, -')NIAi."T P1.11.,K)HINIS N 15. GENERATOR'S/OFFEROR'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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity g fnerotor)is true. Generator's/Offeror's PrintedlTyped Name t Signature Month Day Year -J 1 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: LW 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed[Typ Name Signature Month Day Year a .' QTransporter 2 Printed/Typed Name Signature Month Day Year 9- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type El Residue Partial Rejection El Full Rejection Manifest Reference Number: F� 18b.Alternate Facility(or Generator) U.S.EPA ID Number v LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Z 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 Notice: New federal form. State of California requires generator to photocopy 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a and mail to DTSC within 30 days: Printed/Typed Name Signature P.O. Box 400,Sacramento, CA 95812-0400 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY