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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST t�A )93 f% �, 5 800- 24-9300 007065808 FSE <br /> 5.Generator's Name and Mailing Address INCGenerator's bite (if different than mailing T}dress) <br /> C INDUSTRIAL ltLl�Ls .t�'E.AY �dCID TNDUSTE.IA� ��'t'uii' Ll�i <br /> 114th-3 STRIALES AVE 1140 BE3SEMErt A71E <br /> 1.1ANl'EC,A CA 95337-6108 M9T3TE(�A C� 3��� 7-611�� <br /> bvrA ta( )itiOlGtV.. -7n,^)q-ter_ rt; T.LL <br /> Generators Phon" <br /> q��y�n� <br /> 6 soorYer 1.CpSr1p�).'."1 1 �,{,RA t)(� p •tj <br /> ,~" <br /> 7.Transporter 2 Company Name _ <br /> r;,y=,T� c p: :IT- :;�m`z c- :.{ ; U.S P�t:3ra m ei� s <br /> L SIL. <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> { Nt�fi,s 3?C�16Git) <br /> ;; : £1,gr,, t.aY NEVP IIS?( <br /> HIG.-RiAY 95 <br /> BE= 1TV 69003 <br /> Facility's Phone: 8001--.::,39-.3943' <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NON ACRA HAZARK51US Wny , Li UD (SOAP,PHOSPHATE, i ;) 44-24366, <br /> 0 .. lY <br /> 411 UF:E - �.�F41iii'i 3i.,;' 6 ' 6../• � <br /> Z <br /> 2. 1,1tF limn h9GR1yJG� 9GvG, itpL;Lt tli(idC i t`Ju�E±n vt�;L i, I•!, �f �� '� 1_t <br /> 1 'tJ A 400 <br /> � 1 <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information herogeQl.7 Phone: Cheitrvl 800-424-91W CC118,11; <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> Generator's/0 eror s Pnnted/Typed Name Signature Month Day Year <br /> v O, I 3 <br /> .1 16.International Shipments ❑ / <br /> Import to U.S. Export from U.S. Port of Bntry/exit: <br /> Z Transporter signature for exports only): Date leaving U.S.: <br /> LW 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed[Typed Name nature Mo <br /> ay Year <br /> a �n f I 0 <br /> QTransporter 2 Printed/Typed Na e gnature Mon h Day e r <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Q <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> Ll20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br />