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Please print or type.(Form designed for use on elite(12-pitch)typewdtgr.j Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS t Gf:neralor ID Number 2.Page 1 of 5.Emerge y Response Phone 4.Manifest Tracking Numb WASTE MANIFEST ;`f. •5 tali 7,�,; - 9��,a r t-?�er SKS 5.Generators Name and Mailing Address Generator's Site Address(if dn)eranl than mailing address) ;a(---If'.�1J-t� st:pgt 16iu S R £it Generalers Phone: - 1448--7813 6.T ransportcr 1 Cgmpany Name U.S EPA ID Nunwer !!��1 !a o . VS I'LMS, I NG 1'X 14071RAt 06 J. 7.Transporter 2 Company Name U.S.EPA ID Number 6.Designated Facility Name and Site Address SAFE -Y'-KI-L:F_N OF CALI1-ORNIO U.S.EPA ID Number 680 SMITH All .ibftl 7�3E'S �s2af(!f� {-- {:gC198fd63L741p Facility's Phone: ga gb.U.S-PDT Description(including proper Shipping Na .'Fazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group litany)) No. Type Quantity Wt./vol. m Ni F4,RA HAZARDOUS WASTE,LIQUID YT o FTNYLIFNE GL.YC OL �L7L,LITI.QN (LESS 1-Hil ..iI w z z. w a_ 4. 14.special Handling lnstmctions and Additional Information I"W- VIG 7522,?7)7_ I-tf,-I.- --8100-. -- 41531760 (SK TC'T d RV. l TO NF-I-AiN 15. GENERATOR'SIOFFEROR'5 CERTIFICATION:I hereby declare that the eontonts of thhs consignment are fully and accurately described shove by Inn proper shipping name,and are etassifletl,packaged, marked and Iabeledlplacarded,and are in all respects m proper condition fortranspart ac—cl to applicable internationafand national governmental regulations,If export shipment and I em the Primary Exporter,t certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statenmem identified In 40 CFR 262-R7(s)(it I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's) eror's Print all d Namo Signature - .Month Day Year 16.International Shipments r ❑Import to US. ❑Export from U.S, Port of antrylexit: Z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of R—ifet of Material, oTransporter I innsdiTyped Name Signature Month Day Year M Transporter ante yped Name Signature Month Day Year } 18.Discrepancy --1 Rsidue Ise.Discrepancy Indication Space e Quantity Type LJ Ll Partial Rejection ❑Full Rejection Mimi Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U w Facility's Prion,. 18c,Signeturs of Alternate raatlhy(or Generator) Month Ray Year 4 Y CM 19.Hazardous Waste Raper(Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and mriyclmc)systems) 1. 2, 3. 4, 20.Designated Facility Owner or Operator.Cortification of receipt of hazardous materials covered by the manifest except as noted i.)tem 18a Printe5(N drrypeamgnaure e �`e SitMonth Day Year s �^ P f, f � FPA Form 6700-22(Rev.3-05) Previous dditions are obsolete DESIGNATED FACILITY TO GEINERA70R