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Please print or type. (Form designed for use on e1i (12 -pitch) typewriter) Fnrm Annrnvprl MP Nn ')nrn-Onla EPA Form 8700-22 (Rev. 3-05) Previous editions are bsolete. GENERATOR'S INITIAL UUVY UNIFORM HAZARDOUS 1. Generator ID Nu i iber 2.1 Page 1 of 3, EmeTency Response Phone 4. Manifest Tracking Number WASTE MANIFEST 1 .-1 .7 0028.10806 SKS 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) 17,%7 E MAR'! (11 MIS i- 1-1 IC COC OCKTON CA T� 21 0 5 Generators Phone: 6. Trans o�l Company Name U.S. EPA ID Number _ 7. Transporter 2 Company Name U.S. EPA ID Number 8, Designated Facility Name and Site Address AFU;S, =,..TY-K..ET:N SYSTEEMC- I NC EPA ID Number -OCIPER CREEM WILD A i TYWIT760-3371 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 Packing Group (if any)) Quantity Wt.Nol. 1. J 0J. tD006. D007, D008) LU C -P 3. 4. Instructions and Additional Inform 14. Special Handling Instruction 3 tion C c, ,;g q- 3-7 838 C S V: 24 HR EMEK-11"'ING-V 4,,1-800-468-1760 (SAFETY-K.FEN -- CONTRACT #94138) Ai 7i ^ Y, 1, 4 7 1 � I rA i - AP7 I -Q 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 res$cts in proper condition for transport according to applicable international and nafional 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 EPAAcknowiedgment of Consent. I certify that the waste minimization statement ide tified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Generato.es/Oft?rs P ri cl/TpedNaTe Signature Month., Day Year -1 F-- 16. International,Shipments 1:1 Import to U. E]Export from U.S. Port of entry/exit: 9 Transporter signature (for exports only): Date leaving U.S.: LO� Ll 17. Tran5pbrter Acknowledgment of Receipt of Materials Transporterl Printed/Typed Name Signature 1�-; Month Day Year 0 Z Transporter 2 Printedrryped Name Signature Month Days Year 18. Discrepancy 18a. Discrepancy Indication Space El Quantity El Type ❑ Residue Partial Rejection Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number LL Facility's Phone: w18c. Signature of Alternate Facility (or Generator) Month Day Year Fn- 19. Hazardous Waste Report Management Method Cods (i.e., codes for hazardous waste treatment, disposal, and recycling systems) Uj 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. GENERATOR'S INITIAL UUVY