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Please print or type.(Form designed for use on elite(12-pitch)typewrer.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response one 4.Manifest Tracking Number WASTE MANIFEST CAC002785359 1-887&5-722s 006985179 FLE 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) ht Tmt E. I M Street racy, CA 95376 Generators Phone—904-21 33 6.Transporter 1 Company,Name U.S.EPA ID Number kdwxied{:herrrrcat Transport Inc. (SV) CAR000070540 7.Transporter 2 Company Name U.S.EPA ID Number 51k133 esignated Facility Name and Site Address U.S.EPA ID Number C herr cal TrleatmentNMD002206627 Edith 13hd NENM 87107 ity's Phare: 5 9b.U.S.DOT Descnption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes Hrd and Packing Group(if any)) No. Type Quantity 1NtNol. 4on-RCRA Hazardous Waste,UquidTp p 223 0 Z 2. LU 0 3. - - i I i 14.Special Handling Instructions and Additional Information Project Number 56858 Downent#:D65183 )ERG#; ACT2W15 LEA- 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 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 generator)is true. eneratoes/Offerors Printed/Typed Name ignature Month l3a—y---7e—ar —r 16.International Shipments E— ❑Import to U.S. Export from U.S. Port of entry/exit: z Transporter signature for exports only): Date leaving U.S.: w 17.TransporterAcknowledgment of Receipt of Materials Transporter PrintedrTyped Name Signature Borth Day Year 0 Q Transporter 2 Printed/Typed Name Signature Month Day Year t— 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Partial ❑Residue Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ a c' Facility's Phone: 0 18c.Signature of Altemate Facility(or Generator) Month Day a Z Y319.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PnntedfTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)