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Please print or type. - Form Approved.OMB No.2850-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 74. anifest Tracking Number <br /> WASTE MANIFEST t,:A,RpQait4 _ 013183332 F L E <br /> 5.Generator's Name and Mailing Address _ Generator's Site.Address(if different than mailing address) <br /> aw£tsi <br /> d 10 East Gfent L ne Road <br /> Trwy,CA� !95376 <br /> Generators Phone: 21-119-M- <br /> 6. <br /> 111 M_6.Transporter 1 Company Name U.S.EPA ID Number <br /> Cakfo mie Ernvimnmentel&Lim CAR000099910 <br /> 7.Transporter 2 Company Name U.S..EPA ID Number <br /> pt'A Vnd Soon <br /> 8:Desigmated Facility Name and Site Address U.S.EPR Ill Number <br /> POdir -,5ousre Rar ry E+ 1K F l]f I#? l <br /> �:1.5l1 c8�t t�i>7p i�t� ff� <br /> [XtsAncgele-,CA 023-36E0 <br /> Facility's Phone: Bli)0-496-7145 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) Ne, Type Quantity Wt.Nol. <br /> ® 1. Phan RCRA I aZatdo us Weiis,Liquid West@ Ink) M R ;T31 <br /> a 00 <br /> LU 2 Dora RCR A Hamrrlfus Waste,Uqui l e +0) <br /> 3 Non RCRA HWSrdous Waste,Solid 44at ��w j �rt�s,i�w>am,Sian�Y0! ISM P 352 <br /> 30 <br /> 4. <br /> 14.Specai Handting Instructions and Additional Information <br /> iWillil ERC4171 <br /> 2.' aAn pail <br /> 3,W&SW ab dhMs,contaminated yr ,Oil <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION; I hereby declare that the contents of this consignment are fully and accurately described.above by the proper shipping name,aryl are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulatons.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 EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a).(if I am a large quantity generator)or(b)(if I am a small quant +nerstor)is true. <br /> Generatoris/Qff4rors Printedfr d Narp r Signature / j f i Month Day Year <br /> U IV <br /> 16.International Shipments ` <br /> [= ❑import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Mate a <br /> t~ Transpo ffd, i l ed Name } Signature Month Day Year <br /> #_- � � , <br /> Z Transporter 2 Printedffyped Nam Signature Morflh DayYPear <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Rostdue ❑Partial Rejection ❑Fut#Rejection <br /> Manifest Reference Number: <br /> �. 18b.Alternate Facility(or Generator) U.S,EPA ID Number <br /> J <br /> U <br /> rar- Facilily's Phone: <br /> Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z _ <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 2. 3. 4 <br /> { �- �{ <br /> YYY jjj <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in iter 183 <br /> Printed/Typed Nameaft ��L—All <br /> Signature ,....�.-...—w..,,,� _ Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete,/ DESIGNATED FACILITYTO GE ERATOFi <br />