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i w • • Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number �] /� WASTE MANIFEST i'r'.._M.`:_' ; '' �;,...t; '_'..,��::;:' U a 1 4 L�I L J 4 �� Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) t` ! BCS 55) t`.: 4.94EpE iv, t"E CA 052Q� Generator's Phone: C'f3-N '(-!"'9�t3 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.De$igpated FpcilityName and ij!�. ress U.S.EPA ID Number yy ..- Facility's Phone: S- ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1 ;4, FLAMMABLE U(AAD,ill s,Li4 i: ij,p M TR Cu uto o �iSTIL,, TE, 3'OUIDIE) 4a Z 2. w c9 ,E-1 has the a 3. permits for, anInerator ill aec pt the waste thisis 4. shippini 4.Special Handling Instructions and Additional Information t; trk - �+� Pti alAti s10111vC��'E{t RNA L i3E #'lI C>v'SEA .sL,&," APFR 1F'7-;';'.. `TEC'ri'YE!`V)T4N 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. Generators/Offeror's Pnntedrryped Na e,; Signature Month Day Year 16.'ntematiorraiShiprn nts k— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials J' Transporter 1 Printed/Typed Name Signature .-Month Day Year O J fly= IL i 2CTransporter 2 Phntedfryped Name SignatureMonth lDay ear t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑ f Resesid�uueeTI ❑Partial Rjection ❑Full Rejection CONSfest freference�umber. 18b.Alternate Facility(or Generator) U.S.EPA ID Number FEB 12 2007 �a Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous a treatment,disposal,and recycling systems) 23, 4. A 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest epi sept as noted in Item 18a Pdnted(r`,pedtVame ign2ture 1 M,00ntth Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. 'r '� DESIGNATED FACILITY TO GENERATOR