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r-0 <br /> Please print or type.(Form desisted for use on elite(12-pitch)ty ter.) Form .OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Remise PIS 4.Manifest Tracking Number <br /> WASTE MANIFEST , :�- 008689759 JJ K <br /> 5.Generators Name and Mailing Address Generators Site Address(d different than mailing address) <br /> 144c u;dair Valley Express 1019 B"semer Orive <br /> r PO Brix 2583 M1ianteccs,GR 1336 <br /> IvIanteu2,CA 95336 <br /> ceearathra Pim: .,• <br /> 8.Tramporter 1 Company Name U.S.EPA ID Number <br /> Fromouw Environmeataf Se.Mees hpc r <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and SheAddress U.S.EPA ID Number <br /> DK L'bm: n <br /> 300 Chevrort U1.°av L"RTOSOk17602 <br /> (Ami,CA 05020' <br /> Facilitys <br /> 50020- <br /> Facifitys Phone: 707-6133-833 <br /> gar 9b.U.S.OUT Description(including Proper Shipping Nom,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(tiany)) No. Type Quantity MJVol. <br /> 1. <br /> pr Nc-n RCRA Haaardous Wasta, Ligl r d,(Oily Vit atec) G 72.3 <br /> gtL 2. <br /> W <br /> c <br /> • �i <br /> 3. <br /> 4. <br /> i <br /> 14.Special Handling Inshrctio ns and Additional Informal <br /> -� f�rotiie#DIt1204iT ` <br /> Handlers to Le 40HR Trained and Wear Proper PPE <br /> 15. GENERATOR'SKIffEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurst*described above by the proper shipping name,and are classified,pad**. <br /> marked and labelecilplacarded,and are In all rets In proper condition for transport according to applicable international and nail gwernmental regulations.If exporl shipment and I am the Primary <br /> Exporter,I certify that the corants of this consignment conform to the terms of the attached EPAAelanowledgmen t of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(s)(if I am a large quantify generator)or(b)(IfI am a small quanti enerata)Is true. <br /> GeneratorsKftrors Pd*dfTyped Name Signature j 7 Month Day Year <br /> -j 16.International Shipments <br /> ❑Import to U.S. ❑Port from U.S. Port of entrylexit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Mates <br /> � Transporter 1 Printeclfyped Name Signature Month Day Year <br /> a7 ,� -��� -= lam` _ `a.. <br /> a.Transporter 2P n ams Signature Month Day Year <br /> a <br /> ac <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partes Rejection ❑Full Rejection <br /> Manifest Reference Num: <br /> 18b.Alternate Facilely(or Generator) U.S.EPA ID Number <br /> v .. <br /> FachiWs Phone: <br /> W18c.Signature ofARemate Facility(or Generator) Monica Day Year <br /> d <br /> Z <br /> H19.Hazardous Waste Report Management Method Corte(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> '+a 1. 2. 3. 4. <br /> t,s. - 1 e <br /> 20.Designated Fectity er or Operator Certification of race azar materiels covered by the manifest except as noted in Item 18 <br /> PrintedlfypaQ a s mature -�-- ___�_..... .. Mantle Year <br /> EPA Form 8700-22(Rev.3-0Previous / <br /> editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />