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Please prird or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 <br /> U.NIF.RM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4. Ort Number <br /> WA TE MANIFEST ?-$►' - �*"5 1024 420 FLE <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address} <br /> r tiI td@K:s UnW School Ditbid (Siiwa High) <br /> CA 9&W <br /> Generators Phone: <br /> 6 Transporter I Comparry Name US.EPA ID Number <br /> ft. tSV) CAIMIDDROW <br /> Trarsponar 2 Company Name U.S.EPA 0 Number <br /> E Designated Fatuity Name and Site Address U.S.EPA ID Number <br /> Inc <br /> fman S�.soft <br /> Faciiitys Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.TORI 12,Unit 13,Wasps Codes <br /> HM and Packing Group(it any)) No. Type Qrai* WiNot. <br /> 1 ]qAjJkZ Has clouts ra&-W,h eAd.iLo--- boll 51m OF <br /> a X �r&*1i r).re. <br /> a <br /> Z 2. <br /> LU <br /> c� <br /> I <br /> r <br /> i4.Special Handling instructions and Additionai Information spa 40tw UFM nowt k DIUM <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassi'ied,packaged, <br /> marked and iabeiediplacarded,and are in at 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 berms of the attached EPAAcknowledgment of Consent <br /> i 1 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 quantity generator)is true. <br /> Generators! ors Printed,7ypec Namegsure th Day Year <br /> 16.International Shipments <br /> E- ❑Import to U.S. ❑Export from U.S. Port of entrylexit <br /> Trans iter signature for exports only): Date leaving U.S.: <br /> 17.Transporter Arknowl ment of Receipt of Materials f <br /> F- T lR' <br /> P r ea Nam�j gnu � ` � � <br /> 0. <br /> k I <br /> z Tran porter 2 Prvrtedlryped Name Signatare n ay Year <br /> 9 <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejecfien <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA 10 Number <br /> J_ <br /> V <br /> Facilitys Phone: <br /> W18C.Signature of Alternate Facility lar Generator) Month Day `'ear <br /> a <br /> z <br /> CD <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,Ades for hazardous waste treatment,disposal,and recycling systems) <br /> 20.Desgnaled Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noteddIl tem 18a-" <br /> Printedfryped Name F Signature ntn Day veer <br /> EPA Form 8700.22(Rev.3:05) Previous editions are obsolete. yDESIGNATED FACILITY TO GENERATOR <br />