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Please print.or type.(Form designed for4use on elite(12-pitch)typewriter,) r Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS Y.Generator ID Number 2..Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST �1F•-.: 1 5747 011154370 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 38' iaLI*I`0.�tULi TRUCK <br /> 4474.9 N THORPdTt M RD. <br /> LORI,CA .95W2 <br /> Generators Phone?J`4-^49:'4�5 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> E1PA.nROldliEiht AL SL�IR Ae t'� <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address_,�.„ U.S.EPA ID Number <br /> f� ,�1r-> f�PJ,,�F2C7�If�tE;dlnt. Ent°10E:j tPlG. <br /> 1W S001,14 RWR RD. <br /> 'WEST SAC lENTC1,CA, %691 <br /> '416-571-5747 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> 1. WPJ PCR.A KAZARD JtJ:= vVASrTE 501.10 (Oil-, 0f f3Fl.q ; <br /> w 2• <br /> 3. <br /> i <br /> 4. <br /> I � - <br /> 14.Special Handling Instructions and Additional Information - <br /> W!4PIRCrFILl90 ERr-- 171 t ,a o► "��� �, t; ! _ <br /> E'R'tMM'FRAC OR: f k±kiCJ, E0,4RUNMEN'1-.A1.. SE'_RY]CE6 <br /> eNdDLERS 1.0 BE TRAJI JED AND lssg li�.PPRr-,MMo PPL <br /> - <br /> 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, <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 EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(If l am a small quantity generator)is true. <br /> GeneratorslOfferoes Pdntedffyped Name Signature Month Day Year <br /> r' <br /> -r 16.International Shipments <br /> z ❑Import to U.S. ❑Export from U.S. > Port of entrylexit: <br /> Transporter signature(for exports only): Date Ieaving.U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year, <br /> OCL <br /> i. <br /> za Transportet2 Priptedfryped Name Signature Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S,EPA ID Number <br /> _J <br /> V <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Repor1.t Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1 2. 3. 4. <br /> t ;' ( t <br /> 20.Designated Facility Owner or Operator..Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Phntedfryped Name Signature Month Day Year <br /> r` <br /> DA Form 8700-22(Rev.3-051 Previous editions are obsolete. DESIGNATED FACILITY'S COPY <br />