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Preage print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 7.-Pae 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST :CA( 137 1 4,182449 JJK I 100^ 5.Generator's Name and Mailin I Address Gene es ftA, rens(if different than mailing address) nl ! IMlif lshwt Nt Kd&o Shw*i amk?0" CF4 "ill APH I 74-1701h& 17517014&, 171'�I wtwlb-Ta '4-4107 Su4-,t(m , A 05206 Generators Phone: 1,_f-r44 5...JOV 6.T7,1porter I C17any Name U.S.EPA ID Number i r J,C17 16 61 C 1( 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Chrmlic"11 Wwstp 35,?Sj f-91d N'Eft.:W%*1 CA'110)o J kofi.lma,o 0tv 'A 93239 IM..W/I I Facility's Phone: 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1. o*F"Itlimmalikuy Ilk dot'su t44vl 4I N,O 8,9, 110 fit, (W)I (SW WWI kad '2201 Ott` L I) 3. 4. J- 14.Special Handling instructions and Additional Information Pwfik�# al),W40280 F P(4,-0 1 1 Went hopm Pil-,w1wal Kmdl[IC4�Wujw 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 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 EPAAcknowledgment 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. rG7-loes/Offe is Printed/Typed Name Signature Month Day Year RA ► Gf OT Ge 0 Pb -1 1 16.International Shipments I- ❑import to U.S. ❑Export from U.S. Port of entry/exit: F= Transporter signature(for exports only): Date leaving U.S.: LOC 17.Transporter Acknowledgment of Receipt of Materials U j2 Transporter 1 Printedrryped Name Signature Month Day Year a- I )��l ,) m 1Y,P ell i / 1(j ,,I ;E Transporter 2 P60diTyped Name Signature Month Day Year I18.Discrepancy 18a.Discrepancy Indication Space El Quantity 1:1 Type El Residue El Partial Rejection Elull Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number LL. Facility.,Phone: 0 1 LLj 18c.Signature of Alternate Facility(or Generator) -7 onth Day Year U) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 0 -- 1 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/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY