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Please rint or type (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 itUNIFORM P HAZARDOUS 1. Generator ID Number ci 2. Page 1 of 1 3. Emergency Response Phone 4. 6—festTracking�Nu�mjbeerr�WASTE � 7 `� i 0 � JJ K _ MANIFEST C A , (j Ci i"3 >{ } i r? ,00) sl•24-9300 J � 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) HOLT OF CALIFORNIA (S I'C3CK , ON.) P 7,1 90" X i 421 CHARTER 'Pffi' 9:6AY3 f^n=w ,A "681 S TOCKTiiN tys:. Generators Phone: 6. Transporter 1 Company Name U.S, EPA ID Number t' SBURY EtAlirRCrNNE-NTAL SERVICES C A b 0 2 .8 2 /' 7 0 3 6 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number OE'NU VNO rt KE -RD 3ON X100 NORTH .A1.ANEOA STREET C«i.}WTO'N C.A W2212 A T 'J 8 001 ' 33 ' =; Facility's Phone: ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. 1. i 1 343 LU Z _. LU THIS WASTE STREAM HAS BEEN QUALIFIED EOR RECYCLING/TREATMENTATTHE 3. DeMENNO/KERDOON FACILITY IN COMPTON, - CALIFORNIA. THIS FACILITY HAS THE NECESSAR`. 1. PERM! IS TO RECOVE YOUR WASTE STREAM AS I OUALJFIED. OUR EPA NUMBER IS CAT080013352 ?� 14. Special Handling Instructions and Additional Information . HAERC 981 , 128"PROFILE #x'981. 'i, Y26 -in 10- EVA, COGH . L181 : , NONE' AP,' JFRIATE PERS' NAL R I PROJECT# 63674AI5 4 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shippin name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations. If export shipment and I am the Primary Exporter, I'cerdfy that the contents of this consignment confo* 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. Gen tors/Offerors Printsyped Name Signa Month Day Year i t F 1 v f./ /'/ !1 J f- 16.115temational Shipmen % 1:1I to U.S. ❑ Export from U.. Port of en z Transporter signature (for exports only): Date leaving U.S.: 17LLJ. Transporter Acknowledgment of ceipt of Materials Transporter 1 PrintedlTyped Nae Signatu�A l "� Month ! Day Year CL z a Transporter 2 Printed/Typed a Si§Feature' MonthDay ear F- 18. Discrepancy 18a. Discrepancy Indication Space ty ❑ ❑ Partial Re ❑ I ❑ Quantity El Residue Rejection Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number U Facility's Phone: in LU 18c. Signaturg, of Alternate Facility (or Generator) Month Day Year a z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in IteP4,� , Print ped Name M -r ^^-^^- Signature.. -„ ak=. Month Day Year ` ,�' �'"""7F ?.,.'";='"._� _'r::C.�';!' �,%"'r;�'� f �i r�-�`l i-''t�':a'�.• ,,� ,.,,�.�.-•�'y.,�a �,-,,•,� ,mow'•-^'°.e?+w?s-°:- "` =J.�...::N - Z�.. EPXForm 8700-22 (Rev. 3-05) Previous editions afe obsolete. DESIGNATED FACILITY TO GENERATOR