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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UN AZARDOUS 1.Generator ID Number 2.Page of 3.Emergency Response Phone 4.Manipf�est Tracking Number <br /> WASTE MANIF0106" JJK <br /> ESY n ;..+, l <br /> 5.Generator's Name <br /> }}and Mailing Addre s Generator's Site Address(if different than mailing address) <br /> q <br /> Generator's Phone: r ` '1 (-•v,— x''44 S `A U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> er <br /> 8iif;Sky Esntiorcxrrrrdrri_tC 5rrks;i:f;xss• <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.D s gpatpd Facility Name and Site Address U.S.EPA ID Number <br /> �1:tis,cr,aj it; <br /> 7100 f fay=ron`Aay CAYf 8001+;,0 <br /> CA 9562.0 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit '6 Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity Wt.Nol. :, <br /> r <br /> o ! JI. <br /> ,¢l✓-: ( :f.,f"e ' ���A d7 r f t,.°!.•'L),('(A110( � E r•4 t'l ! <br /> Z 2. r t g <br /> M <br /> Uj <br /> yI t <br /> t <br /> t k' <br /> 3 aMLU <br /> receive your waste, and has receW the T. R <br /> 4. s <br /> P E <br /> EE 3 <br /> 14.Special Handling Instructions and Additional information <br /> VIf(axe PPE.,FAG 1.52.f rrtc Terr€Vi;eptttarl 3,;ff tdlt,dt*s5101543.Ma <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 EPA Acknowledgment 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 /> Generator'slOfferor's P�(intedlryped Name Signaturen7th� Day f Year f <br /> d' S" ! ,�. '.i �'`•rJM'K Ij° Al8 v fl'' <br /> it.(' 19, tl <br /> J 16.Intemation6l S ipmen s <br /> j-.. ❑Import to U.S. ❑Export from 6U s Port of entrylexib <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter,1 Prints ped Name f Signature % Month Dayr Year <br /> 0. 1,r, i �.! :� (,._t f . •i !r� _ t e� f f <br /> ZZ�Transporte(Z Pdnfed/Typed Name Signature Month Day Year <br /> N <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 1 K.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rar- Facility's Phone: <br /> W 1 Be.Signature of Alternate Facility(or Generator) Month Day Year <br /> a \ <br /> Z <br /> as19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ® 1 2. 3• 4' <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> Printed/Typed Name Signature Month Day Year <br /> �— <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />