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Vp�� y�� I� l � 1 }�� V V b 2 6 6 2 5 V 3 K S Flease print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-00<'s9 UNIFORM HAZARDOUS i.Generator ID Number 2.Pa e 1 of 3.Erne a cy Re ponse Phone 4.Manifest Tracking Number WASTE MANIFEST JM L '35f'63 I6250 SKS S.Generators Name and Mailing Address Generator's Site Address(if different than malting address) D L;R Tt Generator's Phone. Lo ' U.S.EPA ID Number 6 Vic I- 7.Transporter 2 Company Name U.S.EPA ID Number r.oq F'�.gg ��py T3" '"• ''x� 4� fi=t pip g,Fs' ag" VC I y^� utz_.z.,.TY i2�'f $t`_> ..... ._:'a,f�&,i+x,.43 i'!i'9k...f 3a._• SVC ori 3. ;Se.•s 8.Designated Facility Name and Site Address C! �A-N HAPGR'R 3 OF �I LM I 'MN .L-', U.S.EPA€D Number 1737 W V-14 S NOT 10N CA 90744 Facility's Phone: ga 9b.U.S.DOT Description{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. gyy d'�€ 4"E RA 114 dRgP A'�{x:i�.u $'?:'f.°.3 k...� ...°4,B S..,. P rq S.3 il- LL1 LL. 2. i ul < { 3. 3 g 4. i i g 14.Special Handling Instructions and Additional Information T,S 24 9'$ � 3id�..t'San 4' dk .,PEkJC -'Z��P'� 3.�3;�� k. nA..Y� Y P ul 0, AL#+H AS PalB'�-3'f (. .T'`P14L41CF—MISED aM Cfr-1RRjFRB AS NEC x M 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 classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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 s all quantity generator)is true. Gen orsl0fferors PrntedlT_yppd Name Sign Month Day Year �j"rf _i 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. P of entrvlexit: �= Transporter signature(for exports only): Date leaving U.S.: ui 17.Transporter Acknowledgment of Receipt of Materials 6; Transporter 1 Printedrr Name Signature Month Day Teat rj; (c �t, V VZ 107117 2_ Tran c 2 Pnnted/Typed Name Signa Month Day Year 18.Discrepancy IBe.Discrepancy fndicaticn Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: Ii 18b.Alternate Facility(or Generator) U.S.EPA ID Number .i L� LL' Facility's Phone: ai 18c.Signature of Alternate Facility(or Generator) Month Day Year d' z: 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,dis and recycling cycling systems) Gi 1. 2. 3. 4. �vL 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prtntedlfyped Name \ Signature Month Day Year I�Y � �` r4^— I )�� — E.P4Form �{8700-22(Rev.3-05) Previous editions are obsal te. ESiGNAT FA I TO DESTINATION STATE(IF REQUIRED) 3 76120 0,3 'It 77(77 -