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� RECEI D <br /> PI "ns 70 F4rtnAp ved.OMB No.2D5{I 0039 <br /> iF US 1 Generator to Number 2.Page 1 of 3.Emergency Response Phone 4.MaWtmrt r4kklny y�n�r J O <br /> WASTE MANIFEST � s .a2M U 1 G9 4(', l v JJ K <br /> 5,Generators Na and FAaBingNW � Generator's Sete Address{H different than maNirig address) <br /> ltlYYl�tllplt tab Ste 3W an bed of US NFM � ipra�lnolte McRbolllof L#!i;5lbe 90 an bit of IS NNSA <br /> PA.Bc>rsZ8B/L-7W Uva,, sr+e CA 94551 Cam!HdIh rYr RoOMW CA 95M <br /> Generators Phone: %54122-BM ATM Slid kq <br /> B Transporter 1 Company Name U S.EPA ID Number <br /> Ckftn Harbors EflwiilrorliffmW Serves Ilfx. MAD03WILIM <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated facility Name and Site Addmss U.S.EPA ID Number <br /> Ckin Hmtm es of Son laM LLC Ii=Bril'yr R=d Son ime Ct9195, CAC0594M10 <br /> Facili s Phone 4G&4!S1-.rM <br /> 9a. 9b•U.S.DOT Description(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 WLAbi. <br /> 1 No -I RA htsrdm Wstt BqWd jwwW tended vAfh 1 DM 407 P <br /> Fdrl0lom h- DOPW204 223 <br /> 2. <br /> 3. <br /> 4. <br /> 14 Spodal Handling IrrshuCGonmand A dmmal Information <br /> omen R05PWW Rme 92&4234-�CDntmt 1781 m UAL JEMWvWWj Msptat&Latad d SiZD A bats W S-25zp a 5,1 <br /> RderMe Me=MWdW LX air ftWMQ=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 classified,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 certify that the contents of this consignment conform to the teams of the attached EPA Acknowledgment of Consent. <br /> I certily that the waste minimization statement identified in 40 CFR 262.27(a)(tt I am a large quantity generator)or(b)(d l am a small quantity generator)is we <br /> Generator'sWeroes PrinWffyped Name Signature Month Day Year <br /> A.&aIUM CM Hof US In <br /> 16. ents ❑Import to U.S. ❑Export from US, Port of entryleAt <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter mental Receipt of Matedats f f <br /> Transporter P ame / 5I� Month Day Year <br /> P � ( L d 2 fJ <br /> T nsportar yped Name Month Day Year <br /> x� 101/ <br /> 1 B.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity []Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> r w •\ Manifest Reference Number:i <br /> ISb.Altemale Facility(or Generator) U,S.EPA ID Number <br /> .a <br /> G� <br /> Facility's Phone: t <br /> ft 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 /> 20.DesiOnated F or Oderator�~ recelpl of hazardous materials covered by the manliest except as nded <br /> , - Signature Mor y Year <br /> r f/ <br /> EPA Form 8700-22(R . -1 , ed: ete, DESIGNATED FACILITY TO GE ERA R <br />