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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST [C�97612r: 020403095 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Stif IDEt t WIRE FPt'COD C i 1412,EL F'IN.'L .-TOCK T CI I,GA 95205 Generators Phone: 21G-4E^7 41 6.Transporter 1 Company Name U.S.EPA ID Number Geijr:' L"k G.'•`��it Ch--i4 t i9 �e�`4".'. ;:Ire,. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facillt Name and Site Address U.S.EPA ID Number L ORNI:,OIL Thr'f- FE:R .K0 OLALIS RD 1-00DES-1 0,CA, 953E7 ?c Faciliti's Phone: 2019-86-3-8181 " 9a. 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. LY_ X 1 lNiG t ;�GR_�: r••i: cR.O�'tJ. VV.AS1% �r+`�_', euSed n1i; r ',; U 221 0 W 2. N [14 RCi::�,HAZE tRDi 7_-� i�d:-::=T E L!QU'lD (t l: ':Nudter'i i� ter: � (XJ(d 3. 4. 14.Special Handling Instructions and Additional Information /� USE: 'IJ}a'E`z II'."tr;ICi t f�00Q 1 J 15, GENERATOR'S/OFFEROR'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 small quantity generator)is true. Generators/ s Printed/Type Name Sign Month Day Year s S 9 16.International Shipments F- ❑Import to U.S. ❑Export from U.S Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typ Name Signatur Month Day Year Q7r 2 Printedrrype Name Signatur Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U U- Facility's Phone: im Jul 18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJI 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 18a Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGN TED FACILITY TO EPA's e-IM-NIFEST SYSTEM