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Please print or ked for use on elite(12 pAchAter Form Approved.OMB No,2 <br /> UNIFORM HAZARDOUS 1.GeneratorlDN 2: 1°ot 3. Respo4.Mtest T a Number <br /> WASTE MANIFEST CAR'0 0 0 0 6 8 0 7 3 1 (800)424-naephone <br /> 5.Generaio)" Mai) t� �'a ss CA ) ` <br /> A 1 E & . 11 C.(STOCIffON) <br /> 120 FRANK Yd G(fiCLE• <br /> P.O. BOX lw:R <br /> tZCttTdP! CA 9&"6 <br /> SACRAMENTO CA <br /> • R <br /> 2J 3'3 - <br /> 0 4050 <br /> �- <br /> Generator's Phon <br /> e <br /> 6.Transporter i Company Name <br /> US.EMIDINkimbe <br /> ASBURY E if rG}FSrt4 °TRi S¢ CSSC'A 6D 2 8 277036 <br /> ' <br /> U.S,'EPA ' <br /> 8.0 FacitdyNameand ' ,. U.S. IDN v <br /> M{EM-ELD TRA ER.INN <br /> 100 E.6RONDAGE-ME <br /> K FIELD CA 93307 : GAL000282698 <br /> Faffil a Phona: (661}871.0308 <br /> 92. 9b.U.S.DOT De dpti n(icluding Proper Shippng Name,Hazard Class,ID 10.Conuntiri 11.Total Y2.Uni 13.Waste Cares <br /> HM and Packing group(ii any)) .. T!11" Quantity Wt fVol <br /> 1. 22Z <br /> N4 ..RCRA-HAZARWUSWASN,UQU1 Y WATER)" ;�6 0 1 T-T S3 <br /> W <br /> 2 <br /> 3. <br /> 4 <br /> 14:Special Hand Instructions <br /> Handing an AddrGonal hrforrrraticpr <br /> EFS ENCYGT:C 1'i2 1- Q4 .0O 9 7 * .fP :°OIL A <br /> 0 Y. :� O 9 1:, E ": R TE P A PROTE VE UIP Et4T . <br /> 1,5: GENERATOR'SfOFFEROR'S CERTIFICATION:I hereby dedare that the contents of this oorisignment are fully and accurately described above by the proper stripping namR,and areLLdassifted,packaged, <br /> marked and labeledlpiacarded,and are in all respects In,proper condition for transpod ric�rdbig.to'epplioable intemationai and national governmental regulations,if exports iipment and I am the Primary <br /> Expiaw,I cerMohat the contents of this consignment coafm to the terms of thea of cam <br /> 'I that the k` t idelr8tied as 40 CFR 2 (a)(I I am•a of b CAI APO quantity generator]is true. <br /> Year <br /> i <br /> J 16.International Shipments <br /> ❑Import to U.S. Q Export from U.S: Port of er*yk al: <br /> Z Transporter signature(for exports onIft W to leavng U.S.:. <br /> IM 17.TransporterAdmouriedgment of Receipt of Materials _ <br /> pC T 1need Name <br /> Z Transporter 2 New Signature Month Day YW <br /> 18.Discrepancy <br /> 16.Discrepancy Indication Space ❑ Quantity ®Te °' ❑Residue " Partial Rejection ❑Full Rejection <br /> Manifest Relaeam Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number 77.7 <br /> LL; Fadifily's Phone: <br /> w 18c, a of Facility(at *nth �� <br /> Z .. <br /> 19.Hazardous Waste Report Management od Codes(i.e,comes for hazardous waste treatment,disposal,and recycling e ) <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous is cov 'by the manifest except as noted in Item 18a <br /> PrintediTyped Name oigna ira e ,w Month <br /> afy, yar <br /> t� •'i'•�..I J�+g�„ S �i e.,, ) �� p��l/'!„ c-f f t fy �, <br /> EPA Form 8700-22(Rev.3-05)/Previous editions are obsolete.,i1 J TRAMSPO®RTER✓'S COPY <br /> r. <br />