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Please print or type.(Form designed for use on elite(12-per)typeuvriter.) Form Approved.OMB No.2050-0039 <br /> tUNIFORM HAZARDOUS 1.Generator ID Number 2.Page�A�gency Response Pitons 14.Wntfeet Tracking Number <br /> WA5TE MANIFEST f.1�OC1L�. 7,5i 1 78S 7725 G 0� H ? FLE <br /> 5,Generator's Name and Mailing Address Generators Site Address{'rf ddWent than mailing address) <br /> F w*r2 a OrAW W- K"[UtthJ f.fjk —,#Ell <br /> S TpD�St <br /> Melnlalua, CA X5.-137 <br /> Generator's Phone: ' 4"V-54~ <br /> ransponer 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facify Name and Site Address U.S.EPA ID Number <br /> LIS <br /> Bo�C�� ;11 k0m 5 BA Fpi•`C 3,�ii�()Cli1Ll <br /> B 4t y, �'J <br /> Facilitys Phone: <br /> ga. 95,U.S.DOT Description(including Proper Shipping Name,hazard Class,ID Number, 10,Containers 11.Total 12,Unk <br /> HM and Pecking Group fif any)) No, Type Quantity WLAO. 13.Waste Codes <br /> x, 1N +i�F51 l�.�ucrJ;�u;w f .#ic es ,ci.0 ii sC,a ►r :�F p LillI I A ) <br /> Q <br /> w I <br /> z 2 <br /> w i <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> �Aer+ta.r �3 � a� i'11 ia77'rt4 <br /> FWA"717 07011177"0271 FA,'1U.0 <br /> 5. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are ciassified.packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and nationaf governmental reauiations,If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAA Knowiedgment 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)Ca I am a small quantity generator)is true. <br /> 3enerator's7 eror's Printedrryped Name 5ignature <br /> ear <br /> M <br /> —j 16.Intem8110na1 Shipments <br /> ❑Impart to U.S. ❑Expon from U.S. Port of entrymxit <br /> Transporter signature(for exports on : Date leaving U.S.: <br /> LU 17.Transponer Act nDw�edgment of Receipt of Materials <br /> Tran er 1 Prtntedi Typed Name I, YAW <br /> I <br /> a -^ansporter 2 Nritedffyped Name Day Moo Year <br /> .B.Discrepancy <br /> 18a.Discrepancy Indication Space El <br /> Quantity Type ❑Residue ❑Partial Rejection ❑Full ReJeCdvn <br /> Manifest Reference Number. <br /> 18b.Ahemate Fad4(or Generator) U.S.EPA 1D Number <br /> J <br /> U <br /> Q <br /> � FacilitYs Phone: <br /> w 1Bc,Signature ofAlternate 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 /> 1 2, <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />