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Please print or type.(Form designed for use on elite itch)typewriter.) UNIFORM HAZARDOUS 1.Generator ID Numbe Form Approved.OMB No.2050-0( 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST r ---•.�- - 008159368 JJ K 5.Generator's Name and Mailing Address ' Generator's Site Address(if different than mailing address) Generator's Phone --_so ---- _ '` '0�. ' ' '� '`` F,-• r 6.Transporter 1 Company Name n � U.S.EPA ID Number Lnl�� L? .`-:'•:\�icLJlviS�;�I`Ji�.r� ='�t{`rli'= 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address IO:fs.OT 1tifl U.S.EPA ID Number osc."i S - .. .�+ivii. CA vd t U fi _rS-`__ti•i�__2 Facility's Phone: B! i-=j7-?jC;Q rInstructions cription(including Proper Shipping Name,Hazard Class,ID Number, p(If any)) 10.Containers 11.Total 12.Unit No. Type Quantity W oI 13.Waste Codes -3Zc'T s'ii;us VVSa`LIOU'id lrixO �� Divi ZW f 14.Special Handling Instructions and Additional Information 7`7_ �•r c't.lJ� :lidj 15. GENERATOR'S/OFFEROR'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 EPA Acknowledgment 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. Generator's/Offeror's-Hnted/Typed Name Si at re Month Day Year -1 16.International Shipments ~ ❑Import to U.S. t Z Transporter signature(for exports only): ❑Export from U.S. Port of entry/exit: w 17.Transporter knowledgmeRt of Receipt of Materials Date leaving U.S.: M Transpo rinted/Typed ame O Signature a Moth Da Year yUt ,6 Q Transporter 2 Pnnted/fyped Name F- Signature F-- Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: —J U.S.EPA ID Number U LL Facility's Phone: H184.Signature of Alternate Facility(or Generator) t Z Month Day Year LU19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. .e., 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedfTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)