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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator 0 Number 2.Page 1 of 3.Emergency Response Phone 4.M0018954.844" <br /> aynifg�es <br /> yyt Tracking Numbe�rryg <br /> WASTE MANIFEST Arnat 'a pr:5 i ^.'+.cl.�t4.. .. 0 0 3 9 5 4.8 `'" JJ K <br /> S5.Generator's Name and Mailing Address Generator's Site Address(if different Than mailing address) <br /> CAL TRANS(10)-LOCI HS L[1GI h1:3 <br /> ST GK"2013 8.45 E_FINESIAEET <br /> { Sl't7Ct=;T>:7N,Gam. "".,�''X+1 U:a�, L001,CA Pr;240 I.Jar1, <br /> Generator's Phone:;J.�.ki+3-•372.3-522] - <br /> 6.Transporter 1 Company Name U.S,EPA ID Number <br /> 1011i Enllforur ilal natatO;rsS G.AL1.rA°s.'2'62;3ri�2,3 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address LIS Ecology U.S.EPA ID Number <br /> ' <br /> Hicithk ay 95 ;iJfi tg71 yJ <br /> P9reattp,w 8j)8 <br /> Facility's Phone: WD2193943.21 _ <br /> go. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12Unit <br /> HM and Packing Group(if any)) 13,Waste Codes. <br /> No. Type- Quantity WtAPoI. <br /> 1NON A(,R\ HAZARDOUS ViASSM LIQUID t Vf\TER EASED FAINT, ✓' !3foi °" U` ??>3i �_�___. <br /> o WATER - � ✓✓' .-t-_-- <br /> } <br /> z 2. <br /> out <br /> U <br /> 4. I 1 <br /> (14.Special Handling Instructions and Additional Information - _ - <br /> DED dOEh 3720d01R <br /> 9.9-i1-w&#. r � <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents oTlhis consignment arefully and accurately described abevebythe proper shipping name,and are classified,�packaged, <br /> 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 <br /> Exporter,I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. _ <br /> I certify that the waste minimization statement identified in 48 CFR 26Z27(a)(if l am a large quantity generator)or(b)(if I am a smA quantlty generator)Is true. <br /> GeneratorslOfferm's PnntedlTyped Name - - Signatur Month Day Year <br /> kL , 1c� 3L 14)9 <br /> a. 161ntemailonal Shipments - - - -' <br /> i- - ❑Import to U.S ❑Export from U.S. Port of entrylexit: <br /> z. Transporter signature(for exports,only) Date.leaving U.S.: <br /> -W 17 TranspoderAcknonledgment of Receipt of Materials <br /> Tran�oner 1 Printed/Typed Name - Signature Month Day Year <br /> 10 <br /> 11 <br /> B Transpoder2 Pit nted/Typed am. 'V. - nature Si <br /> g Month Day .Year <br /> ti <br /> 18 Discrepancy - - - <br /> �. <br /> 18ar Discrepancy Indication Space ❑ Quantity ❑Type <br /> El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 186.Alternate Facility(or Generator) U.S.EPA C Number <br /> ZiV <br /> Facility's Phone: <br /> r18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> C <br /> 19.Hazardous Waste Report Management Method Codes(ie.,codes for hazardous waste treatment disposal,and recycling systems) - - <br /> p t IC <br /> 1, o 1 ,I <br /> x1 2, 3 4. <br /> 20 Designated FJcility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 B <br /> Pnnied/T ed,amd""" tv <br /> SignaMp, r' <br /> p „r �'' ,.y.,,.+.s„A Ivlonlh . Day Year <br /> ���<7'",..r"''�" > <br /> EPA Form 8700-2�(R v.3-O ) Previous bditi ns are o6 iBF' p' <br /> ,,�: Q IGNATED FACILITY TO GENERATOR <br />