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Please print or type.(Form designed for use on elite(Q-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2 Page 1 of 13.Emergency Rosponse Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST " A C o 1'1 N C,N I-rAT A-e` 01671.1494 JJ K <br /> 5 Generator's Name and Mailing Address GeneraA Site Ad ress fir different than mailing address) <br /> \IAN D6 Pp�. ENTERPRISES INC. VF1nl L)L PoL, <br /> E NTE R PR+SES �►�� <br /> gSagS 5 AlalpoRT WAV '12.C) e . EIbtNTM11:E RO <br /> 6Tl3L\4XCi?J CA q52-Oka STOC ICTo^4 CA q52\0 <br /> Generator's hone: 10 9 13b'6 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 1 Transporter 2 Company Name F U.S.EPA ID Number <br /> 4..� <br /> FUNUMM <br /> ry" Adrkb89t�rx.ra c <br /> 212so E. 1:5TIA 5T. <br /> $ATAA A2• -%Sstas- 1Cio1 <br /> FacrlitysPhone: 1 A Z9hL2 — <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit <br /> 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity Wt.Nol. <br /> 1 NOt - RLW HAZA(ZDp WASTE r S01-ID C ptC.+� <br /> DEgR\S,A65oR0'6F- 1TT <br /> W P <br /> W 2 <br /> 3. <br /> 4 <br /> i <br /> i <br /> 14.Special Harding Instructions and Additional Information 1 y 16-LODI 010 — 01Ly OF-EM45 I-RG-*1-1\ <br /> x 5$9 <br /> dlsiM�frs+rY+Sarr+n I1 f�1�!r� <br /> 15. GENERATOR'S/OFFERORS CERTIFICATION: I hereby declare that 8a contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded.and are in ati 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 certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identdied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generetor•slOfferor's PintedlTyped N Signat re Month Day Year <br /> ` C O'tJ <br /> —J 16.International Shipments <br /> Z ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Dale leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Mal enafs _ <br /> Transporter 1 Pinted7Typed Name Month Day Year <br /> O <br /> a <br /> 2 Transporter 2 PinintedfTyped Name na <br /> Si w e <br /> Q 9 j. Month Day Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑ <br /> TYPe ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Attemate Fadlity(or Generator) Manifest Reference Number: <br /> U.S.EPA ID Number <br /> J <br /> U <br /> LL. Facilitys Phone: <br /> W 18c.Signature of A)temate Facility(or Generator) <br /> Q Month Day Year <br /> Z 19.Hazardous yJaste Report Management Method Codes Q.e.,codes for hazardous waste treatrtant,disposal,and recycling systems) <br /> C 1. 2, <br /> 3. 4. <br /> L � <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Name Signature <br /> Print Na r�-t %( l / Monty Day Year <br /> � <br /> V t <br /> EPA Form 8700-22(R v.3-05) Previous editions are obsolete. G J <br /> ESIGNATED FACILITY TO GENERATOR <br />