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Please print or type. Form designed for use on elite(12-pitch pawriter. Form Approved.OMB Na. <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4, anifest Tracking Number <br /> WASTE MANIFEST 014 7 8 3 02 9 J JV1 <br /> 5.Generators Name and Mailing Address Geoeraloes SlteAddress(if different than mailing address) <br /> BE-1-103'ril> <br /> �.^'ri <br /> 5MCKTLN,CA 95:.'041 <br /> Generators Phone: "•• 9 =b71 eQ02i21 •`; i <br /> e.Transporter 1tComp4rfy Narne" US.EPA 10 Number <br /> GetfsT�e�/.l'd7'1Y►>f;11TC: - . ..i.. .. . ....... . .. ... tar5¢?nq��a7•t7'),^,, <br /> 7,Tmnsp000r 2 Company Name U.S;EPA ID Number <br /> _.. .:..._....... <br /> :.... _ <br /> e.Desigynated Facii' .Name and Site Address U,S.EPA ID Number <br /> t�At� SfELC ixtAiU�Fc^n IRIC. ��..�� �.:• <br /> :. :S.AISE'IQ,aF(ELD,CA =07 <br /> ge, 96.U.S.DOT Description prichtditig Proper Shipping Name;Hazard;Class,ID:Number,• „ ... ........:... ..10:Containers.. 11:70tal 12,Unit13.Waste Codes <br /> li N: and Packing Group'(if any)) ...._..._.. :.......:... No. Type Quantity wtivol. <br /> oa ±f 1. C4JON R..CN(A M.A7AA1301.1S VAl. �- 1% 1`0 !'>3.L!30RVr-N-r$" 4),;", <br /> w 2. <br /> 0 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information ; <br /> y:KtIv#171 1 , <br /> -•�"�j" t. <br /> 16. GENERATOR'SIOFFEROR'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, <br /> marked and labelediplacarded,and are In all respects in proper condition for transport according to applicable International and national governmental regulations.If expoh shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknovdedgment of Consent <br /> I cattily that the waste minimization statement Identiffed in 40 CFR 262.27(0){if i em a large quantity generator or(b)(NI am�smaliquantlty generator)is true. <br /> GeneratoedOfferors Pdntedrtyp ams Sre th Daay, Year <br /> A 16.International Shipments <br /> ❑import to U.S. D Export from U.&:"-� Port of entryfaxiL <br /> Transporter signature(for exports only): Date leaving U:S.: <br /> Ix i7.TransporterAcknowledgmenlofReceiptofMaledals <br /> Transporter 1 P ntedrryped Nam Signa bre._ Month Day Year <br /> .. . . ..— K .1 &.. <br /> Transporter 2 PdntedrTyped Name 1,$19nature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space 1:1 Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> . • Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Ga . <br /> LL Facility s Phone: <br /> 18c.Signature ofAflemate Facility(or Generator) Month Day Year <br /> Q ' <br /> 19.Hazardous WaFste Report anagement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G1. 11 r / (-.% 2. 3, 4. <br /> J / f <br /> 20.Designated Facility Owneror Operator:Cenifieation of receipt of hazardous materials coypred by the manifest except as noted In item 18a . <br /> Prinlecirlyped Namei t' ; ( r 1 1 r Signature 1 Monl�r Day; Y�ac•• <br /> EPA Form 8700.22(Rev.3.05) Previous editions are obsolete. TRANSPORTER'S COPY <br />