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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 1 1.Generator ID Number UNIFORM HAZARDOUS i 2.Page I of i 3.Emergency Response Phone 4.Manifest Tracking Number i WASTE MANIFEST N10 JJK I i 1 002182 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) lewfix,"ill'ick 4q ,,i �ihw4,i P-14 W�,Odk Generator's Phone: i-,I I I 6.Transporter I Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number 01d, 1V J-1,i%Ai I i Kk114h'1M011 Cwy,CA Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 0 i I Uy 1 1,00 1R y with lcavl OK 2 1-ifol s Z 2. Uj 3. 4. 14.Special Handling Instructions and Additional Information °3, t'; ( 1,P('� esti wvm Pfoav,l PIT wlo,)k iiawfilrifMwe,�'Ojl 15. GENERATOWS/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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 quantity generator)Is true. Generator's/Offeror's Printedfryped Name Signature Month Day Year Rid LaL�-rc� Arfi\)L E�La Gj�n:,RL, , temational Shipments El import to U.S. El Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: 17,Transporter Acknowledgment of Receipt of Materials Transporter I Printed/Typed Name Signature Month Day Year 0 CL U) Transporter 2 PrintedlTyped Name Signature Month Day Year I18.Discrepancy 18a.Discrepancy Indication Space El Quantity El Type El Residue 0 Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number LL Facility's Phone: a I LU 18c.Signature of Alternate Facility(or Generator) Month Day Year !-R Z tris 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Uj1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(fyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY