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Please print or type. Farm Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4. it "7 7N 7 WASTE MANIFEST . -%4.f300 44' 8i9 i ;'ti;s-ei' t_ r;. a� .y 5 G B F �.r t afs 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 1'0'Sr1 11tiA1OVA110114S C��i_i1 C;F2i t1 e (?35 S. 11W'7 99 10C 4 i I C N,(;.A `w J.)-15 Generator's Phoned ;,,r;c.c.. ;t.;l 6.Transporter 1 Company Name U.S.EPA ID Number livd4_t41C>a7i VNI.1-EY WA,131 :04t.. INC. 7.Transporter 2 Company Name U.S.EPA ID Number si _f- '1 -Y'VVA,131' -S01,i.01101\1 INC, P v`>'1i?fti it4"J'%4 8.Designated Facility Name and Site Address U.S.EPA ID Number GLIA-ftAN(.3-ti i C:C7F:4)f:1rA,E.t C:. f;q(j�1f�f4itR '1F1� '4 1855 WHITt<4-:0t;K RE). f,'A4�41,i-10( 0N CA, 95*i it 2 Facility's Phone:. 9a. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes L 0 # 6;tr111 h.L6:flf3t=lJ4J.`a.+A✓ :7�:.1. t.11 -«'uF7ll,+A{ a; Nifty ty,.. h•4•» w z 2. LU P��i4 FtC:Ftr"441A�!A4iLK?i}5 WA i1 i.11,,xC311),Ix4,ALK`(L.I-A(vIEIH i'L ;ai C9 , 13rPL'�r°1_AMMC)Iy1A04 01A, Pd•r�tKY4.4.?1fv1FE1F4YL F:3't 4Yti31 4�•' - I .'1.Iv13;A0PJIUfA 0111- 1,VDL 3. t �4 ttC:FiA Ir Afill)044:::VW44:3i h_:iOLIL), (+,N1AF10TAS15411tv1 EMS'1 rR0XITIt0lvl0SUI-F+IA b-')431w(.13ULKIA'TE) 4. i•t�,�is-Ft4:8A F iAt:/+.(SIJC1l.zE:4NA;.1:F i..IQtlli), 1-00i:)0F(Ftit:'k; C:K:lAi ii4t::: A 0 DI'll IVfn. 14.Special Handling Instructions and Additional Information t-i#ht11-1t'4tYl�?( kr3?s1�-4�(9�-i+igt' iC`.h� E121�" "Iry }-"�'ti> C:+Eit_I !/ iW:1s5:34•iltt VilliALOXIL)L, kttt7tP ii`s ti i:''4ROF'ILE# 1646231J4t+: �?=:-,full-♦ CTANFCEEANER 4 F1R(.1FIL.t.# 1646236-00PACIRVIE 17--RGO 171 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 EPAAcknowledgment 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 Printedfryped Name Signature Month Day Year + r i .j 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: Ce 17.Transporter Acknowledgment of Receipt of Materials LIJ Transporter 1 Printedfryped Name Signature ,.' Month Day Year CLI ZTransporter 2 Prin ed/Typed Name Signature ' " Q 9 Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ QuantityType❑ yp ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U ra+ Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. J. Notice: State of California requires generator to photocopy and mail to 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a DTSC with 30 days: Printed/Typed Name Signature P.O BOX 400 Sacramento, CA 95812-0= 00 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPS'