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Ple seprint or type.(Form designed for use on elite(12-pitch)typowritei-j
<br /> UNIFORK HAZARDOUS 1.GendratorlD Number -P Form Approved.OMB No.2050.0039
<br /> C , , " 2. ,I�jt 4.Manifest Tracking Number
<br /> WASTE MANIFEST 0 j
<br /> JJKonerl s Name and Malling Address 04-60*
<br /> r:1 Gone
<br /> krV 1 TF UCK Generator's Site Address(If different then mailing address)
<br /> VVESTERN TRUCK'0,ENTEP
<br /> '40— 3.H I G,
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<br /> -S iz,
<br /> Generator's,PhPhone: 7 .r. T
<br /> .6.Transporter I Cbmpany Name ........ ..........................
<br /> F(' 'K U.S.EPA ID Number
<br /> V -L—S ip,!,,
<br /> u v L' S Ek k"
<br /> 7.Transporter 2 Company Name C A R 0 0 o -1 0 .1 -i
<br /> ,r,-I- I W6.EPA 10 Number
<br /> 8,Designated Facility Name and SlieAddress C A I,'!
<br /> E U.S.EPA ID Number
<br /> 2303 W.AUU�fiEDA SITEIET
<br /> C-0kfjPTrX,,1 CAL !D0222
<br /> Facility's Phone 3'ICI 6,37L 7•i00
<br /> C A T 0
<br /> ga. 9b.U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 112.Unit
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<br /> �NN 0. NType tQlanli WINcl. 13.Waste Codes
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<br /> I-Rcr um -
<br /> FL(,(V%fiABLE 1-10LIDS,WAS,,
<br /> 3',H(DO3 1 200- 1 DO, 18 43,
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<br /> 3,
<br /> 4.
<br /> 14.Speefal Handling Instructions and Additional information
<br /> c-. `tree E,E
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<br /> AM TijcT,,Mr--,
<br /> 15 GENERAT(kirSICIFFEROWS CERTIFICATJON- I hereby doclare that
<br /> Ine.conjenis of this consignment are fully and accurately described ati6ve by the proper shipping name,and are—classifled,packaged,
<br /> marked and laboledfolacarded,and are In all respects in proper condition for transport according to applicable International and national governmental'regula o a rt 8 man ands am!the Prl '
<br /> U.n�.-Lfex0--hip —t mary-----
<br /> Exporter,I arfl64at the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Com-drit,
<br /> J cortily that the
<br /> waste minimization statement Identified in 40 CFR 2 62.27(a)(if I am a large quantity genBrator)or(b)VfI am a small quantity generator)Is true.
<br /> enora�e$/O,fferors Printed/Typed Name Signature
<br /> Day
<br /> Month,
<br /> I k, Year
<br /> t
<br /> 16.International
<br /> x
<br /> ernAtional Shipments.
<br /> 1:1 Import to U.S. ❑Export from U.S. Part of entry/exit Transporlet signature(for exports ordy):
<br /> M 17.TranO orterAcknowledgment of Recelpt of Materials Date leaving U.S,;
<br /> Transpod6r I Printedffy—podName
<br /> Signature gnature
<br /> -?0) Month Day Year
<br /> Ica
<br /> Z Transparlor 2 PrInled[Typed Name
<br /> /
<br /> -Io
<br /> Signature
<br /> 0-
<br /> —
<br /> Month Day Year
<br /> 18.Dlscfepancy
<br /> 18a.Discrepancy Indication Space
<br /> E] Quantity Type ❑Residue Partial Rejo'clion El Full Rejection
<br /> '18b.Alte7,*,.I,Facility(or Generator) Manifest Reference.Number. U.S.EPA ID Number
<br /> L<L': Faclilly's Phone:
<br /> 180,Signature ofAlternate Facility(or Generator)
<br /> Month Day Year
<br /> LLJ1 Ir
<br /> 119.Hazardous Wasfe Report Management Method Codes(I.o,,codes for hazardous waste frea(rqont,disposal,and recycling sysierns)'
<br /> 2.
<br /> 3.
<br /> 4.
<br /> 26.besignated Facility Ownpror Operator:Codification ofrecelptofhazardoui materials covered by *manifiesi ex� a's�.§tedlnkerm 18a
<br /> Printed/Type Name--
<br /> Signature
<br /> 1� k� . il •, Month Day yea
<br /> Zj �•.� �
<br /> :-PA Form 8700-22(Rev.3-05) Previous editions are obsolete.
<br /> DESIGN��'-1 TED FACILITY TO GENERATOR STATE{IF REQUIRED)
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