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lease print ortype, Farm Approved.OMB No,2050-0039 s <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifestTrarkk€fig Number' I <br /> WASTE MANIFEST � =r 1,8.87 i�srt ��3 trG�' 0 1 ,3 9 10 C?6 JJK <br /> 5.Generator's Name and Mailing AddFoss Generatoes.Slte Address(if different than mailing address) <br /> oLD <br /> 4202 G.DFA I ER <br /> STOCK]"ON,CA psi 3 <br /> Generator's Phone: <br /> 6.Transporter1 Company Name VS.EPA ID Number <br /> E <br /> �ersr���sF. LrM•��n�,Itit~. � �:��u��t���`I=��. , <br /> 7.Trfsporter 2 Company Name U.S.EPA ID Number <br /> t C / <br /> 8,Designated Facility Name and Site Address U.S.EPA 0 Number 1 <br /> IBAKERSFiELD TP,„AMSFE <br /> 1920"E. BRLiT;IDAGE Ln <br /> i <br /> Faciiity'sPhone: F_jE.;-YZ2-;;2�,Z I <br /> 9a , 9b.U.S.UOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packfnq Group(if any)) 13.Waste Codas <br /> No. Type Quantity Wt.fVol, <br /> t t+Cr A RCCA HAZARDOUS SOLID 011y EbSvrbStiro 'DDI P 62 i <br /> � 1 <br /> >;r i <br /> � I <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> E f: fig!:�r11=1>~. F)R01.1L� <br /> ;,f r G!L2 r <br /> , <br /> lel <br /> 15. GENERATOR'SfQFF1 ROR'&CERTIFICATION. I hereby declare that the contents of this consignment are ful#y and accurately described above by the proper shipping name,ard are ctassified,packaged, <br /> marked and labefedlplecarded,and are-in all respects in proper condition for transport according to applicable intemaMonaland national governmental regulations,If export shipment @lid I am the Primary J <br /> E cparter,fertify tfrat the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent. s <br /> I ce'fy tha the waste m#nimizatlon statement idem lied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(iff am a small quant ty generator)is true. <br /> i Ganorat QR orsP6ntedfi'gpe me Signature Month Day Year- <br /> 13 <br /> a 16:International Shipments t <br /> {J Import to U.S. ❑I~I:pod 11.U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving.U.S.: <br /> 17.Transpaiterkcknowledgment Of R6041 of Materials <br /> Transpodtt��LL1 P['I.I�cTped flame Signature Month Da Year <br /> r <br /> ,Ii'�S53iC�Lt�'l. 1 - y <br /> Transp. 2 Print !typed Name Si natur <br /> g Month Day Year <br /> . f8.D erepancy <br /> IBa.Discrepancy IndicationSpare ❑ Quantit ❑ I 01`01 Rejection <br /> Quantity ❑Type Residue Partial Rejection <br /> j <br /> a <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S,EPA ID Number <br /> t Y <br /> o ? <br /> Facility's Fhone: <br /> i 18c.Signature of Alternate Facility(or Generator) Month Day Year j <br /> 19.Hazardous Waste Report Management Malhod Codes(f.e.,cones for hazardous waste treatment,disposal,and recycling systems) <br /> I <br /> i <br /> I <br /> 7.p,Design d Facility Ovanerar Operator. rdl cation receipt of hazardous materials covered by the marl€€es3 94 <br /> t4f.)ESICNATEID <br /> j <br /> Printedf d 5g rMonth Year i <br /> i <br /> 'A Form 8700-22(Rev,12-17) Pre oils editions are obsolete. F:AC L Yy T pS a-MANIFEST SYS T $t <br /> I <br />