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tea§ ;picot 6r : l pmt a 49WlSr_w (z (i -itch}.fypet�nitaY 3 7 r'�. fE- far' 3� 91 ,::. . F6rm}ftipraved,O! NG.2i650.003t <br /> (J�ttFbO HA7�11tt OUS t.Ganeratof ID Number 2.Pagel of 3;Emarga Response Ph6ne 4.Matti TrT c <br /> WAM MANIFESY FL <br /> E. <br /> _ Qk(J�vti (/ <br /> . _ �.._ _...._.- <._ •_•..: ,_ , _ . :_ t. . 8 J H kms . <br /> 5.Gener8tord Nameand Mailing Address GoAmtor'sSitoAddresg(fcgffamntthmrrraiRngaddress) <br /> St .051t=Ph'S Gang.. <br /> 1800 N California St:. SAM: <br /> -�SWcktarl,CA 95204- <br /> Gdnerltar's;Phdrre: - - - <br /> 5.Transportar-1.Company U.S.EPA ID Number <br /> C . <br /> 7.TranspoAer 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facillty Name and Site Address U.S.EPA ID Number <br /> Clean Harffors El Dando LLC <br /> 309 American Circle A R D G 6 9 7 4 8 i 9 2 <br /> F,ppppoo.AR.7030; 8,10_ <br /> ga. 9b.U.S.DOT Desc4ption(fn r pp e,Hazard Class;ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity WtNoE. <br /> 1. <br /> 11M07.WASTEORGANIC PEROXIDE TYPE E.LIOUID.(35% <br /> ()0 1 <br /> x PEROXYACEfICACID,ST x STABILIZED). Z PG fir <br /> to � <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> I-CH588694 EFtr�lk3 45 <br /> FL., 5;6 Z <br /> 15. GENERATOR'S/OFFERORS 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 condftion for transport accordin.gAo applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I ceAify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste mini zaton statement identified in 40 CFR 262.27(a)fd I am a large quantity generator) (b)(if i am 6 small quantity generator)is true. <br /> Generato s ror's Prints yp Name rg ® on y Year <br /> 113 <br /> -J /6.International Shipments ❑Import to U.S. EIE.P t from U.S. Port of entryf A <br /> Transpoder st nature for ex its only): Date leaving U.S.: <br /> 17.TransporterAclmoutiedgment of Receipt of Materials <br /> OTransporter i PdntedfTyped Nameigna ay ear <br /> Ru a A t f.S 9G I`�'� -- � 17.. 11 1 f 3 <br /> Q Transporter 2 POWNYTyped Name sgnature - Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> .181J.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> t3 <br /> Faa'k1 a Phone: <br /> 18o,Signature ofAltemate Facility(or Generator) Month Day Year <br /> x:.19.Hazardous Waste Reprint Management Method Codes p.e.,codes for hazardous waste treatment rtsposal,and recycling systems) <br /> 't. <br /> 20.06signated Facility Mar or Operator:Certification of receipt of ha2A*us materials Covered by the manifest except as noted in item 18a <br /> Printed/TypedName. S5natum Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DEsI NATED FACILITY TO DESTINATION STATE(IF REQUIRED) . <br />