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Please print or type.(Farm designed for use on elite(12-pitch)typewriter) FormAppfoved,OMB No.205H039 UNIFORM HAZARDOUS 1 1.Generator iD Number 2 Page 1 of 3.Emergency Response Phone 4. an sl7re ng Number WASTE MANIFEST (800)424- , 01823125! JJK 5.Generalor's Name and MaEng Address Generator's Site Address('d diferent than mailing address) &1;.r 4d'j&j.#ji W: FAMIUdYO) 7520 A 7524 M0 FUME RID 3ACF2IIMEHTO CA &5#: :!%fPAMEPITO _J =5: Generators Phone: X2331 n" 6.Transporter i Company Name U.S.EPA ID Number ElKALSERVICES CAnn ''77036 7.Transporter 2 Company Name U.S.EPA[D Number 8.Designated Facility Name and Site Address - U.S.EPA ID Nwnber AVErN" ,cutslrlr i2TH STREET' u:-..T'"' ■' 8 3 AZROQ0002428 Facility's Phone: 9a. 9b•U.S,DOT Description(indudmg Proper Shipping Name.Hazard Class,10 Number, 14.Containers HM and Packing Group{if M)) No. Type Quantity 1tMNaE 13,Waste Codes rr 1 a ' I i;z 1 c � fir z z e, 3. 4 14.Special Handling Instructions and Additims!Information MENCY 00WAC'i CHEWIR1EC ICOGL424-93400 HAERN M2 171 *F?IWFI LE 9P OM Irl•00 -TfN.FR;E rr,Y q-* AM CWNTREC 1-8C4424-93M 'ADDITIOMAL EFA CODES -9ft , r E -APPROP'WIF PE AL P#kD7E, pff I e jr:) 15. GENERATOR'SIDFFEROR'S CERTIFICATION:I hereby declare that the contents of We consignment are rorty and accurately described above by the proper shipping name,end are classified,packaged. marked and labeledlplararded,and are In al respects in proper condition for transport according to applicabie inlerw6onai and national governmental regulations.If export stamen!and I am The Primary Exporler.I certify that the contents at this consignment conform to The terms of the attached EPAAcknm%ledgment or Consent. I certily that the waste W nimization statement identified in 40 CFR 262.27(a)(111 am a large quantity generator)or(b)(HI am a pmall gm9ty generator)is true. Generators101ferors Prmtedlryped NxTe Signature Month Day Year ..r 18.Intepm oonat Shipments F El Import to U.S ❑F.xpaR hen U.S. Ront of antrylexil: Transpoder signatum(for exports oniy): Date leaving U S.: 17.Transporter Ad=wledgment of Receipt of Materials Transporter 1 PrimedlTyped Name Month Day Y.-.: a Transporter 2 Printedriyped Name Signature Month Day Year 18.Discrepancy 18a,Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Re)eGian ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number V ii Facilit?s Phone: 18c.Signature of Alternate FacEity(or Generator) Montt Day Year Q Z y19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycing syslems) 1• 2 3. d. 20.Designated Facility Owner or Operalor Cerfffication of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prime ed Name ^ Signature Monk Day Year EPA Form 8700-22(Rev.3.051 Previous editions are obsolete DESIGNATED FACILITY TO GENERATOR