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Please rine or tyv ' r. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generalar ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking N�umber'y C ,C WASTE MANIFEST CAL"I 5V@5 8&-;;JBS.7225 t,9 1 2 8 lJ d 12 r L C 5.Generator's Name and Mailing Address Generalor's Site Address(if different than mailing address) Con-t-ab Calibmia, LLC 1910 lir. Latrl= Road LathnI, CA 953-30 Generators hone: 7 7A 6.Transporter 1 Company Name U.S-EPA 10 Number Adlmnced Cherttical frar'ispoi•1 Inc./DBA AC-TEWIRO OARV tW705M 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number C:hamlcal Waste Mart dent CA'1 "117 35251 Old Skyline Roaa KeMemen Cly, GA 93239 Facility's Phone: 5514-35"711 ga 9b,U-S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit and Packing Group if an Quantity WI.NoI. 13.Waste Codes HM n9 P( Y)) No. Type N 1Non-RCRA.'I-a ardirjus Waste Sclfid(Grill) y 352 2. 011 ,10poploo Gpd-UOQ 3. 4. 14.Special Handling Instructions and Additional Information Project Niviber 10,M14 D1•IfaUiY7i C2342c2 •i) C;A G16739 CG(.;- 15. GENERATOR'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, 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 cefgfy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste m'nimizalion statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(14y1 a)rrra small quantity generaW)Is true- GeneratorslOReror's Printed/Typed Name Signature" Month Day Year A '°fid " ��° Pli 16.International Shipments �1:1 ' Importto U.S. ❑Export from U.S. Port of enlrylexit: Transporter signature(for exports only): Date leaving U.S.: OC 17.Transporter Acknowledgment of Receipt of Materials- ILLJ Transporter 1 Pdntedrryped Name Signature < J Myth 0" Yew N Tfansporter2P ditypedName Signature Mo* Day Y� , 10,Discrepancy J 18a.Discrepaney tedk8lon.Speae ❑t Iiangly ❑Type ❑Residue ❑Partial Relectioh- ❑F11R*c1otl / ! i Manifest Reference Number: 118b.Alternate Facility(or Generator) U.S.EPA ID Number eat Facility's Phone: a� 18c.Signature of Alternate Facility(or Generator) Month Day Year Z 19.Hazwdous V40 Report Management MOM Codes(Le.,codes for hazard w waste Ueakrrmrt,disposal,and recycling systenre) 20.Designated Facility Owne or Operator:Certification of receipt of ha4dous materials covered by the manifest except as noted in Item 18 f - -• i Printed/Typed Name r Signature Month_ yea / G •1:�7 EPA Form 8700-22(Rev.1T7)`Previous edi8or) aye obsolete. DESIGNATED FACILITY •0 GE EPA OR