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3. <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest <br /> Tracking NumberWASTE MANIFEST i? ii. i'. a " i i.a':e; t •:i t <br /> JJrk <br /> 5.Generator's Name and Mailing Address Gi3ner ss Site Address(if different than mailing address) <br /> P 0 BOX 8i99 <br /> d'_", ',',A F52 ' CA 95212 <br /> GenerSi en: <br /> _.. <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> r"11h'4416.. <br /> 7.Tra spo r 2 Company Name U:;EPA ID Num/bier <br /> } ,�ti 1 <br /> $A u k. _�.;,tall u}+ �v%r < <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CRI,"k`h8Fi'r`;r((AAFF((:'N <br /> 193-110 jtif. 17TH 1ij Pr_[_:a <br /> Facility SSBhJA3 l'rr-.:Aj-'H f A. <br /> 9a. <br /> 9b.U.S.DOT De,@XA4(ItidlA8gr Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> 11.Total 12.Unt <br /> 13,Waste Codes <br /> HM and Packing Group(ff any)) No. Type Quantity Wt.No(. <br /> i.rtlr� <br /> E)(� `�=if<i 111 rt:.P'Atrl I Pt:L.fit,..t3(111Al:.P�oFtl1..,3 PG I)j T} Yy,iLU <br /> 's R <br /> E <br /> 3. <br /> t V <br /> I <br /> 4. I <br /> t <br /> P <br /> 14.Special Handling Instructions and Additional Information <br /> rp ❑ ff 714 <br /> .,T�.. <br /> 15. GENERATOR'SIOFFEROWS 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 1 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 I am a small quantity generator)is true. <br /> GeneratorslOfferoes Printed(Typed Name Signature Month Day Year <br /> _ 16.International Shipments import to U.S. ❑Export from U.S. Port of entrylexit: <br /> U.S.:vin <br /> l <br /> t <br /> Z e leaving Transporter signature(for exports only): Da >1-1 <br /> p <br /> W 17.TransporterAcknowledgment of Receipt of Materials <br /> 12 Transported 1 PrintedlTy adRdame Signature f ' ,^ 4 Month Day Year <br /> 0 11" :r ! .. .f' 10 Z 3f, <br /> CO) Transpprter 2 Printedrryped Name ;Signature ) ti Month Day Year <br /> 18.Discrepancy II��II.�� �� <br /> 1Be.Discrepancy Indication Sp9.c%,EFEF Umaniih M WAS RELVIVIA) Ibaprt>tYB�AND STURW FOR SU eOFpSIR Partial Rejection ❑Full Rejection <br /> t1KJSAL,TREATMENT OR REi,SE.CAUSBY&OVERTON,INC.OPERATI S.TFiE FAaU Y UNDER <br /> ,_Rmrr5 GRAANTM TO TI IE.M.BY TF•�DEPARTMENT OF TOXIC SUBSTANCE mber. <br /> .",r.r - S OF U.S.EPA ID Number <br /> 18b.Alternate Facility(or GewtatT*SotstCE CONsERVAT10N AND RECOVERY ACT Off 1996 TOQEJM WITH AFP.B, BIM <br /> J ITY)F RAL .AND STATE REGUTA13ONS,'CROSBY ! ON*EiTON HAS ALL OF 7Mi NECESSibw <br /> V "ERMrrS TO ACCEPT THE RFY1W..NCFD WASTE AND ALL THE WASTE HAS'BkEN HAW jM <br /> u Facility's Phone: '`MRDrNGLY <br /> C3 18c.Signature of Alternate Facility,(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. T <br /> 14* <br /> r, <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pik ted(f ed Name Signature r �.� y^ Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />