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ase print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved . OMB Nov 2050.0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2, Page t of 3, Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST 0 3 7 ? 1 U -�- v' JJ K 5. Generators Name n� Mailigg A�dress t Generators Site Address (if different than mailing address) rr ; ! aitTnoMIli H,-' t. ri ! rr §`NNLi . IP1t 17830 SOOTH IDFAI PARFWAY MANTf t3A CA 953? Generator's Phone; 6, Transporter 1 Company Namer U.S. EPA ID Number r ; . I(`? 0NMENTAL !r jCF tVl ' 2 1L 7, Transporter 2 Company Name U.S. EPA ID Number 8, Designated Facility Name and Site Address U.S. EPA ID Number Y+C. it - C. t) It . l� ?. t , yr; I 0A ?004IN AtF.f',A [ bA ' ,TF2E_t'T tt �M 'r'7 !iM r :4 (, A1ttn00 'L3352 01 Facility's Phone: tML i7' 7 ! cif , ga. 9b. U.S. DOT Descriplion (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 , Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No, Type Quantity Wt.Noi. 1 . . : l Lp +JN1993 . WASTF Fi :1'J :; 1'4ABI E t IQUII?a hi ; , , ; ; � , . oliKYOLINF/DII I-) 3 . frail r : I i 2 I 3, 4, 1!' I 14, Special Handling Instructions and Additional Information n(�(j �4 ?yft W(►E` 'FERMINAI . CF !7FS r,� t�f�Effif�# 'SE31 128 F PIFII. I # 9 Al t t3'xf 9rr?41 ^ 930! INF/(yF�, 1"t APPROPMATF PPF FQIJIPME*NT 15. GENERATOR'SlOFFEROR'S CERTIFICATION : I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classed, packaged, marked and labeled/placarded , aq: are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and ] am the Primary Exporter, I certify that the contents of this consignment conform to the terns of the attached EPAAcknoxledgment of Consent. 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, Generaton'slOfferor's Printedfryped Name Signature Month Day Year r 16. Internalional .Shipments ❑ Import to U.S. El Export from U .S. Part of entry/exit: Transporter signature (for exports only): Date leaving U,S.: i 17. TransporterAclmowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Signature Month Day Year Transporter 2 Printedffyped Name Signature Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. 18b. Alternate Fatuity (or Generator) U.S. EPA ID Number i Facility's Phone: i 18c. Signature of Altemate Facility (or Generator) Month Day Year C 19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) 1 2 3, 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 183 Printedrryped Name Signature Month Day Year 'A Form 8700.22 (Rev. 3-05) Previous editions are obsolete. GENERATOR' S INITIAL COPY