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- ECE� D <br /> PI -ns � 20 F4rtnAp ved.OMB No.2D5{I 0039 <br /> iF us 1 Generator Io Nbe1 2.Page 1 of a.Emergerrky Response Phone Msr�.,n rl�lny y�nr J O <br /> WASTE MANIFEST ; � 13. . .a2M U 1 G9 4(', l v JJ K <br /> 5,Generators Na and FAaBingp��Bss � Generatar's Site Address(If different than malling address) <br /> ltlYYl�rlplt rteare tab Ste 3W an bed of US NNSA Lwow LINVMM Naffwd f Lob Sloe 90 an beiiw3f of IS NN3A <br /> PA.Bore E03/L-7W Uva n sr+e CA 94*hi Cotes!HdIl Yr Roadfraq CA 95M <br /> Generators Phone: %54122-BM ATM Slippkg <br /> B Transporter 1 Company Name U S.EPA ID Number <br /> Men Harbors ErwifronmenW Service Inc. MAD03WI IM <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated facility Name and Site Address U.S.EPA ID Number <br /> fi aM Ito bcn Of SOD M LLC I=arn'yem Wall! Sn ime CA 9SI CAC0594M10 <br /> Facili s Phone 1-£arD1ti0 <br /> 9a. 9b•U.S.DOT 1Des*fion(including Proper Shipping Name,Hazard Gass,ID Number 10.Containers 11 Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity Wt1Vo1. <br /> 1 lllorsE-MRA hoA dMM Wstt BqWd jwwW tended VAfh 1 DM 4o7 P <br /> j 'kirdfi'rlllR hv�yDOPW204 <br /> 2. <br /> 3. <br /> 4. <br /> 14 Spodal Handling inshuctonmand Addtional Information <br /> r r R05PWW Rme 92&4234-�Cmtmt 1781 m UAL]EMOj Dlsptaltch.Lwd d SiZD A D=W S-25zp a 5a. <br /> RderMe Me=MWdW LX an bWmQ=MW6 <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassifed,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.I(export shipment and I am the Primary <br /> Exporter I ce*that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I cadly that the waste minimization statement identified in 40 CFR 262.27(a)(tt I am a large quantity generator)or(b)(i l am a small quantity generator)is we <br /> Generator'sWerars PrinWffyped Name Signature Month Day Year <br /> A.Graham cm beh&of US NNA � <br /> 16.NMi0*'% <br /> Wents ❑Import to U.S. ❑Export from U.S. Port of entrylexit <br /> Transporter signature(for exports only): Date leaving U.S..- <br /> W. 17.Transporler meat of Receipt of Materials <br /> Transporter P erne / 5I� MoruEh Day Year <br /> P /& L d o <br /> T nsporter yped Name Month Day Year <br /> x� <br /> 1 B.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantty []Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> r w •\ Manifest Reference Number:i <br /> ISo.Alternate Facility(or Generator) U,S.EPA ID Number <br /> .a <br /> G� <br /> Facility's Phone: t <br /> 18C Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> a <br /> S2 19.Hazardous Waile apart Management Method Codes(1.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 2o.DesiOnated F or Oderator tf recelpl of hazardous materials covered by the manliest except as nded <br /> Signature Mor y Year <br /> x f/ <br /> EPA Form 8700-22(R 1 ed' ete. DESIGNATED FACILITY TO GE ERA R <br />