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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2 Page;1 of 3.Emergency Response Phone 4.Manifest Tracking Number 4.l,oa> 4��- ops WASTE MANIFEST `f A 11 0 E] P O 'y, 5 9 4 `G I r� � � j Y F L E , j - 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) !u3� Sq1utJ;_ -r;3, -;.?Ye- Quik str. MA- - t,zr Fn:- is •i f 1721 a chftr c ke?` f,r1 Generators Phone: (510) 445--22$2 6.Transporter 1 Company Name U.S.EPA ID Number i E;1L24141_RF "'P�n a n 1. rs 4,9 6 ..i 7.Transporter 2 Company Name __. U.S EPA ID Number I 8.Designated Facility Name and Site Address U.S.EPA ID Number 2000 N. Alp-mieds q-t! Campton, CA 5 02 12' Facility's Phone: P ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 1o.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WI.NoI. 1. t2i12t?2, c=;za1g�::.'t.1t�< ; vri j w Z 2. tHIS WASTE STREAM HAS BEEN QUALIFIED �- FOR RECYCI I 3. DeMENNO/KERDOON FACILITY IN COMPTON, CALIFORNIA.THIS FACILITY HAS THE NECESSARY 4. ..._..._.-._._�....- QUALIFIED.OUR EPA NUMBER IS CAT080013352 i 14.Special Handling Instructions and Additional Information , x EPG*: 123 7ZR0?111i "ZI : 27 2503 4 t.t2 - 1 X ,55 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 naflonal 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. Generators/Offerors Printedfryped Name gnalureont ay Year f Cl,A �, � i..� � ( 6F 1 J 16.International Shipments t-- 1:1 Import to U.S. ❑Export from U.S. Port of entrylexib Transporter signature for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials i Transporter rintedrryped Name Signature Monthay Year U z Transporter 2 Prinled/T ed N me Signature �' Month Day Year ; a .�- �- - ' 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type 171 Residue 1:1 Partial Rejection ❑Full Rejection i 1 Manifest Reference Number: h H 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q LL- Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ 11 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a; / Printed/Typed Name Signature 77{ f Month Day Year - f } f CII IC I1.M II.F EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. �•.- `\DESIGNATED FACILITY TO GENERATOR