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0orwa lr" itr, SEtl t�a cr7µ'� tor. D l n P.5u,a.ftx 400,,. rC afi't' W,CA MIU511400 WNW 30(lay <br /> Please print or type.(Form designed for use on elite(12-pity q typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 13.Emergency Response PhoneManifest Tracking Number <br /> WASTE MANIFEST CAR��►72 1 rojon517517 <br /> JJ K <br /> 5.Generator's Name and Mailing Address —._ - __. Generators Site Address(if different than mailing address) <br /> e9 Er 9.``�cilxk9 <br /> SWM4*6 CA <br /> Generators Phone: 209432.67M <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> VV#fgMh EMilikt gwMal CAM241320 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address GWIM of ROW16I U.S.EPA ID Number <br /> RX010 mat CA 96742 <br /> ty'. 1 1- ... �. 1S3_ <br /> Facili s Phone: <br /> 9b.U.S.DOT Description(including Proper Shipping Name, azard Class.ID Number, 10.Containers 11.Total 12.Unit <br /> and Packing Group(If any)) — 1,Wash Cudes <br /> r No. Type Quantity Wt.Nol. <br /> �! e1Q�, t� f3ttr� t k�mt t.r. ►.1, _. 611 -- <br /> a,, DA <br /> "`Ite; "Aoxw..2.4 N I i,,hw 0 <br /> 611 11 NA- <br /> DIM14.Special Handling Instructions and Additional Information{ �e <br /> Ma 8041163 #MHGP ESTLP-00 /e'��* a <br /> 9b2,,ERG 0154 PPORLE 13267 4M ;`r,..�► <br /> !;FNtERATOR'S*FFEROR'S CERTIFIC.ifION• nxaoy de;late that the: f this nor c;nrnwit are fully and accurately de c!ibed abo-a b1 the proper shipping name,and areWsnifieu,r i:aged, <br /> rked and Iebeledlplacarded,and are in re n proper con;m. 4,. i x.a.. ding to applicable international and national gow ;"I rogulations.If export shipment a an ay <br /> 3ai+xtor,I certify that the contents of this umsig,Mt con'-,"to u e(emr,; itcj: 1 —,mowledgrnent of Consent. <br /> j d 1 cert!that the waste minimization staloment ide oiled in 10 CFS f?.;r'f ntiry generator)or(b)(if I am a small n.iantiry generator)is true. - <br /> i � YPpc we `� ' Y Year <br /> Genet at 4"',Q fero s Pdntedrr ed ame 1 Si nat A h, na <br /> G r f, / ' r <br /> f r i,re. 0,7ilStipments <br /> I Imp',t to U 6, 1 Expo"1: Poi' 't onuy/exit <br /> t_. <br /> I I _',sp-+rr signature(for exports only): __ Date?eaving U.S.: <br /> mrisporter Acknowledgment of Receipt of Materia:,-, <br /> IJ <br /> ptL rx 1 PdntedlTyped Name Signature Vonth� Pay Year <br /> Z.1 rr ispnrinr^.Printedrryped Name Signature Month Day Year <br /> q '8.Jscrepancy <br /> 18e Disnr,;,ancy Indication Space 1 r <br /> L] Quantity ❑Residue I Partial Rejection I...�roll Rejection <br /> Mai!:,estReferenec Nur:.ar. <br /> j= 18b.Alternate Facility(or Generator) ry � _a U.S.EPA ID Number �. <br /> J <br /> V <br /> "C Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Ody Year <br /> a <br /> Z <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ 1. 2. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as need in Item 18a <br /> Printed/Typed Name Signature Month Day F Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL�COPY <br />