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Ploase print or type. (Form designed for use on elite ( 12•pitch) typewriter.) Form Approved. OMB No. 2050.0039 <br /> UNIFORM HAZARDOUS 1 . Genorator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST c A R 0 0 0 0 7 3 5 s 1, 600 ) 4( 2 i- 930G 0 8 7 0 3 4 3 JJ K <br /> 5 . Generator's Name and Maling Address Generators Site Address (if different than mailing address) <br /> J - ; er r I NAGLEE RD <br /> :5 ( � � RTI ; P,IAGLEE ROAD <br /> CA 95376 <br /> Generator's Phone: ^07 834 1111 <br /> 6 Transporter 1 Company Name U.S. EPA ID Number <br /> v Ji ; NIENT�kL SERVICES C A U 2 7 7 0 3 6 <br /> U.S. EPA ID Number <br /> 7 . Transporter 2 Company Name <br /> WCiRLDWIDE RECOVERY SYSTEM INC . G A N 0 0 U 1 i bit 2 2 <br /> 8. Designated Facility Name and Site Address U .S. EPA ID Number <br /> i tJ Iii ; iir.t� i_ tYlc 1J l . If l <br /> +5500 US HIGHWAY 95 <br /> i U ( . lA A7 85365 FC 0 0 0 5 <br /> Facil ly's Phone: el n ': 'I ^ <br /> 9b. U.S . DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Total 12 , Unit 13. Waste Codes <br /> 9a No. Type <br /> Quantity WtNoi. <br /> HM and Packing Group (if any)) <br /> t . , •JN , KRA HA'ARDOUS WATTj <br /> " , SOLID tr'ni cr; CIO Fli <br /> 0 <br /> Z 2 ; ON RL' RA HA?AP, DOUS WASTE . SOLID ( OILY SOLIDS) r. <br /> r' <br /> 3 . <br /> 4 , <br /> 14 , Special Handling Instructions and Additional Information <br /> i ly1ERGENCY CONTACT CHEMTREC 1- 800-424-9300 WOES TERMINAL CERES CS NAAF`P, G # 9131 : 171 , 982 : 171 P bF L <br /> X81 162Ea2 ? I')IRSTRAO78 PAPER FILTERS . 9132 : TRA078162623NRS OILY SOLIDS '' " APPROPRIATE PPE EQUIPMENT <br /> 15. GENE RATOR'SIOFFEROR'3 CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard are classified, packaged, <br /> 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 <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consant. <br /> I certify that the waste minimization statement idontified in 40 CFR 262.27(a) (f I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br /> Ger ratoeslOfferoes Pr nledfryped Name Si naturo Month Day Year <br /> International Shipments <br /> 16. try <br /> F., ❑ Impo U.S. Export from U.S. od of en tacit: <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> 17 . TransponerAcknowltedgmant of Recapt6f Materials <br /> W <br /> l <br /> - - -- MonDay Year <br /> Transponer ledTyped Name S gnaure C <br /> 1O <br /> ed Name S! re Month Day Year <br /> Q Tra YP � � _ <br /> H <br /> 18. Discrepancy <br /> 18a. Discrep y Indicafiou Space ❑ Quantity ❑ Type Residue ❑ Partial Rejection ❑ Full Reject on <br /> Manifest Reference Number: <br /> U.S. EPA ID Number <br /> F}- 18b, Altemate Facility (or Generator) <br /> J <br /> F <br /> LL Facilily'sPhone: Month Day Year <br /> C3 18c. Signature of Alternate Facility (or Generator) <br /> a <br /> Z <br /> CD <br /> 19. Hazardous Waste Report Management Method Codes (i .e ., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1 I 12P _ 3 4 <br /> 20. Designated Facilit Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year <br /> Prntedfl-yped Nam Signature <br /> G! �UCA IvU <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. - DESIGNATED ACIL )0O DESTINATION STATE ( IF REQUIRED) <br />