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Please print or type Farm Approved OMB No 2n5r.0,03c <br /> UNIFORM OUS 1.General&10 Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest TraTrcki BNumber 7 F L E <br /> WA NIFEST C/4!. 000 220 540 -4'�^ 510-541-2128 <br /> ll <br /> 5.Goagreter's Nent�aaand Mali Arddross Generato,'s Site Address(if different than na,liN address) <br /> (i0lt�ll bi L ' <br /> 3033 S.Airport Way <br /> SIOCIIW.CA 9WMs <br /> Generator' 289-295-7700s Phone: U.S. � <br /> EPA 10 Number <br /> E.Tra-sporler 1 Company Name <br /> S� Sky Envimmm al Solutom C�.�umber 0 _ <br /> 7 'rrs iter 2 Ccmoan Name U.S.EPA ID Number _! <br /> Eft !O! 435 642 742 <br /> C Dn �tgyjy Name and Site Address �O U S.EPA!D Numner <br /> �figharty 11 mks south of <br /> ih STI r NV 8:3003 NIM M 10M <br /> 1463-2m <br /> Facility's Phone: <br /> 9, 9b.U S.DOT Description(including Proper Shipping Name.Hazard Class,ID Number. 10.Cantainer5 11 Total 12.Vit <br /> HM and Packing Group(if any)) No, Type Quantity WLNol. <br /> C.. X52 <br /> o Won-RCRA HUGIdrINIS M11111o.S41W (D"*) <br /> Uj <br /> 3, <br /> 1 <br /> 4 — <br /> .I � <br /> ansiructions and Ad <br /> - �! 0101�8900Z6101 <br /> EMROENCY COWTAbCT.EFF RHODES <br /> 15. GENERATOR'StOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,ant are classified,pnCKan+:d. <br /> marked and labele0placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am ire Pn:r,ar; <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimiza6an statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ill amLailtity generator)is e. Month pay Yeac <br /> GeneratceslOHerofsPrinted/Ty ed Name Signature <br /> 16,international Shipments t --11 Import Import to U.S. ❑Export from U.S. Pott le wing U.S: <br /> ? Transporer signature Ila,exports only): Oslo leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> r L41Signature k1onN D y Yea <br /> lot <br /> Transporter 1 PrintedlTyped Name \ r / } '✓Q <br /> Z Trarsperter 2 Pr ntedRyped NamL\ Signature <br /> C Dtsuepancy j <br /> r—� <br /> tCa,Discrepancy Indication Space . ❑ Quantity ❑Type ❑Residue ❑Partial Rejection U Full Reject= � <br /> Manifest Reference Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> a <br /> Facility's Prone: 61o^.th Dav `'ea• r <br /> 18c Signature of Aiternale Facility(or Generator) AO <br /> t n I <br /> Q IW <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,ami recycling toms) <br /> 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of ter—eipt of hazardous materials covered by the manifest except as noted in Ilam 18a <br /> Print IT ped Nae Signature _.... Month civ Year � <br /> EDA Form 8700-22(Rev.t2 t7) Prevlouseditions are obsolete. DESIGNATED FACILITYTO GENERATOP <br />