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'7i42 Please print or type. (Form desiqned for use on ell (12 -pitch) tvoewriter.) Fn" An-n-rl r1AAR Ain onrn_nnzo EPA Form 8700-22 (Rev. 3-05) Previous editions are�bsolete. I; ? 87i 150194 GENERATOR'S INITIAL COPY UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Nu ber_ tt�� 2. Page 1 of 3. EmCCtterg�e77n,cy Response Phone d� 4. Manifest Trackiin�4g/N��um�jb�ierp}�{ /�j C KC 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) MiC131?i..1- AIP".OW CORP. 17 r MnR'Tlw . if: I IN ' _ .4: i OCKTON CA 952115 Generator's Phone: 6. Transporters 1 Company, Namek U.S. EPA ID Number t 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address . C z ,J E�^-A Ui. PIID Number i�(-L:tlf-,1-�.i,..h:t�,I'+! +3Yr.��iz"�>�� Fe:G. .1��:.^i. 1200 1Bq T #� STq Fr PCRAMENTO , CA 9582-S Facility's Phone: 9a, 9b. U.S. DOT Description (including Proper S ipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and PaGroup (if Quantity Wt.Nol. i Cckingg HIP -1 "NON US N RA HIP `1 "iRIA n lib'48-rr} E 5 I._ s w 1 o :"'} oW T , .T�~ =4�EW_" 9 1- it Z 2. W 3. 4. 14. Special Handling Instructions ation S'rJI �r..049,.:1-err 549-7766,,3 .; 71t;Q38 t IG. - 2 if HR EMERGENCY #1'"8+710 68-1760 (SAFETY--# LIE:EN - CUNTRAI." T 494138/ 15. GEN ERATOR'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 resp cts 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 consign ent conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement ide tified In 40 CFR 262.27(a) (if I am a large quantity generator).or4( ('if I am a small quantity generator) is true. Gen+eerator's/Offerorep Printed/Typed Nam `j"*•. � Signature �i/�►j�A Month Day Year Jj �f ��' �.'� Jfyy{)J(�/]fes � %�jf� I.� I / f � "" " K,fiy� ! .. � , t ! . � / r✓' �• �,\...! f J H 16. International Shipments ❑ Import to U. ❑ Export from U.S. t' Port of entry/exit: K 1 Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Transpprter 1 Pdnted/Typed Nerge Signature. Month Day Year CL QTransporter 2 Printed/Typed Name Signature Month Day Year H 18. Discrepancy 18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U u Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year a z H19. Hazardous Waste Report Management Method Cods (i.e., codes for hazardous waste treatment, disposal, and recycling systems) LLJ � 1 2. 3. 4. 20. Designated Facility Owner or Operator: Certification f receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are�bsolete. I; ? 87i 150194 GENERATOR'S INITIAL COPY