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-..... r--..r-•.•-•.*.•--'`-*^^�---•"-.-.--,-."',7"+-`�":n'c^��-�-ara•+r•-^.. 1_...:..... .r•-.�-.�.._. .,.--;.�...._....Y.,........ _. ...._.��-^^---•r---••Pr•--••.'-*--"r-�•. <br /> rT <br /> Please)gint oNfiCr Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS i.Generalor ID Number 2,Page 1 of 3.Emergency Response Phone 4.Ma t T ac I g uper, <br /> WASTE MANIFEST r7 -, U° l 2,8 F L E <br /> 5.Generator's Name and Mailing Address Generator's SlteAddress(If dlfferenl than mailing address) <br /> Con-Fab Califbirnia, LLG' <br /> 1910 E. <br /> Latg Road <br /> nero; Ne� � <br /> Gerapso <br /> d290 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Adinnrud 01F-4ilicA T'rarT7_,pjr4 Im./DBA ACTENVIRO CARCO 070W <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> C',lanlical Masts mar 1�1'1t CA'iC3t?R1fl�b'117 <br /> 35251 Old Skyline ROM <br /> Kettlet an City, CA 93239 <br /> Factiitys Phone: c 7 <br /> ga 9b.U.S.DOT Description(Including Proper Siupping Name,Hazard Class,ID Number, 10.Conta ners 11.Total Q.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.No1. 13.Waste Codes <br /> 0 1 Nc)n-RCRA Hazardmis Watae Se id(SLA CM �� Y _ 35) <br /> 0 <br /> W 2. RECEIVED <br /> 3. MAR 1 i �Oi9 <br /> 4• Con-Fab California, LLC <br /> 14.Special Handling Instructions and Additional Information Project Number 195317 Document-4: D234425 <br /> 1) C'A81573J,,,, M � <br /> A P3 tf <br /> 15. GENERA70R'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this conslgnmeptare bray and accurdtely descr bed above by the propg�,sfmg name,aid are classified,pad aged i <br /> marked and taWledlplacarded,and are in all respects in proper condition for tran5pod according to applicable internationaland naoonal governmerilal regulaII&S,I(exportshiprimrit and l Ginn tti'e t5rinlary <br /> Exporter,I certify that ft contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I cortify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator}'bT(b)(III am a small quanfily generator)is true. 1 <br /> Genera oep/Ofleror's Pd ��}d7Typpped Name Signatufe f // 1 Mont/h7 Day Year <br /> Genera <br /> _i 1 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? <br /> Transporter signature(for exports only): Datele4vingU.S.: "" <br /> Q: 17.Transporter AcknoMedgmentofReceipt o(Materials <br /> Transporter,4) d7Typed Name Signature Month Day Year <br /> Transporter 2 Printed/Typed Name Signa lyr6 Month Day Year i <br /> 18.Discrepancy .I <br /> 18a.Discrepancy Indication Space <br /> ❑ 4uanlily ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection t <br /> r <br /> Manifest Reference Number: <br /> 18b.Alternate Faulity(or Generator) U.S.EPA ID Number j <br /> _.r <br /> V i( <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year k <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,deposal,and recycling systems) <br /> � <br /> 1. ) 2. 3. 4• <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materlais covered by the manifest except as noted in Item 18a <br /> Printed yped NameS'nature Month Day Year C <br /> u��� �� a��• (.; ��Z�j�r y� 1/t`� _ - D 3 0 } `'I <br /> EPA Form 8700-22(Rev.12-17) Previous edilf ns are obsolete. U DESIGNATED FACILITYTO GENERATDR <br />