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WMN�FORVH <br /> pe.(Form designed for use on elite(12-pitch) riter.) Form Approved.OMB No.2050-0039 <br /> AZARDOUS 1.Generator ID Number Page 1 of er a Phone 4.M nifesIIT rackin Nu ber <br /> WASTE MANIFESTk� `� Q 8 f 9 3 9 2 JJ K <br /> 5.GeneratorsPe Qhl il� dresS,� Generator's Site Address(if different than mailing address) <br /> TRACVK,'M AUTO PLAM WAY ) C��tllTO Pt.ASA WAY <br /> !RkCly AW CA 9M <br /> Generator's Phone: � t <br /> 6.Transporter 1 Company Name U�.ER IlfVuatbert 7 1 0 3 6 <br /> A1$N.1P'Y EI�lV RON*NTAL SERVICES t, ll f� <br /> 7.Transporter 2 Company Name US EPA ID Number <br /> 8.Designated Fac'I Name and Site Address U.S.EPA ID Number <br /> MIir�N )j K,ER>DC3 4 <br /> M. NOPTH ALMEA-A STET <br /> (;Q£'.IPT0N CA 90222 f_' A T 0 8 0 0 1 3 3 5 2 <br /> Facility's Phone: 0im&17-7 i00 <br /> 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. <br /> o i` )t4.RCjRA WWD04..I IS,Y41A.STE, I IQUID(OILY WATER) <br /> 001 • <br /> z 2, <br /> w <br /> c7 <br /> 3. <br /> 4. <br /> 14.Special <br /> H�ranndli0ng InstructionsandAdditional Information <br /> h?r�tE/'{.5,3R ! APPROPRIATE[1 ! _pR(WILf'PERS <br /> SMI <br /> �y�a�a��'(y'E.��I��flt ENGY�{ - TTAAfsTy. `MQ REG 114 f.�3-�'.24- it,)a.AM IlONA1 EPA t `.> . <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 labelediplacarded,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/Offeroes Pdntedffyped Name Signature Month Day Year <br /> )i <br /> 16 International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> � <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> a J6 <br /> Z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> F-- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Spacety <br /> ❑ Quanti ❑Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <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 /> 0 1 2. 3. 4. <br /> 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedfryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />