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r Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response one 4.Manifest Tracking Numher WASTE MANIFEST k;A OW/8561 , �# a .� G B F I' 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) LJIIB14"IINl)UW f'EtradlcC r LLC: i'I'i N.SIJ 1'TE, 9520!)9520!) BTC.rt R S•1 ft 30 800 F (IM1R,AiN S;( ?7> Generator's Phone:80U--"A 1-93U0 ;ir)fJ f:;\ 96203 6.Transporter1 Company Name U.S.EPA ID Number AME-%ICAN VALLEY E011.,110:. i;Hi.t11JQ8'ti7818 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Faci ity NA*iind Site Address QEIV1_I"CI.1 r C0.R0 iVA,L-LC. U.S.EPA UNumber 11855 WHITE ItOOK.fir.). t.At�r?BfJtig41�i3 FtAIaCI10 CfyftCiQVr\,CA95742Facilites Phone: 810-35"I-Of#9U ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WINol. 1. IyhN•RC RA JIWA.FtV1r1t.JS WA.VI.;:S01,If) 1 IJ.�A 1Nf) 1' 223 O OILY PIPE 4a M 2. W 3. i 4- 14.Special Handling Instructions and Additional Information Ff2C3#171 E FI2C ENC-Y 0014 FACT: BILL L 111 LE: 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 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgrppnt qXc� lent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if Iam a large quantity g rat k)or_ )j f•lam a small quantity generator)is true. GeslOfferor's Printed/ryp •N e ., a Month.. Day Year � llaa�.Juga` ,pments u t- Import to U.S. - Export from U.l:" Port of entrylexit: Transporter signature(for exports only): , - Date leaving U.S.: w 17.Transport rAcknowledgmentofReceiptofMterials �' T Trenspo P'nted y dName - Sgn allure ._ Month Day Year o QTra s ort r h ed1Typed,Na Sghatyre � Month Day 18.Discrepancy t y 18a.Discrepancy Indication Space ❑ Quantity ❑Typej j A ❑Residue ❑Partial Reaction ❑Full Re action Manifest Reference Number: • : 18b,AlternateFacg7y(or Generator)•---- - U.S:EPAIDNumber ' J v LL Facilitys Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. y ti F- 2. 4. � 1�r1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name ,, 1) Signaturgy Month Day Year LU EPA Form 8700-22(Rev.3-05) revious editions Ore obsolete. DESIGNATED FACILITYTO GENERATOR