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Form Approved,OMB No.205x0039 <br /> Please print or type. 2•p e t of 3-Emergency Response Phone 4.Manifest Tracking Humber a <br /> U�l1FORAiI HAIARD�US T.Generator ID Number a9 � i7' <br /> n 09 <br /> wASTF MAHlFEST ti.=�.i:r�-: :tom=":. � ��� � � a��,;��� J J <br /> C_,_,r •-aiors Name and Mai4ng Address neral s Site Address(if different than mailing address) <br /> E FIAVW INC <br /> -.101 MlAfMN LUTHER KING :R EL,�10 <br /> =TCCKTON.CA 95205 <br /> Generators Phrnre 230--476-$5e7 <br /> U.S.EPA ID Number <br /> S.Transporter 1 Company Nam <br /> CRRO(}0047+319 <br /> piorter 2 Company Name U.S.EPA ID Number <br /> 1. <br /> `C 1 rpt C ft—LC,G G U 3[� G 1 �. <br /> U.S.EPA ID Number <br /> GALbCY123;95 <br /> 15207 E.BRUNDAGE Lrl <br /> BAKERSFIELD.CA 9,2,M7 <br /> I Facility's Phone, 2«1425$ <br /> 9b,U.S.DOT Description(incuding Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11,Total 12.Unit 13.Wasle Codes <br /> HM and Packing Group{d any}) No- Type <br /> Quantity WI.Nal <br /> 1' 140N RC RA HAZARD GU9 WO S rE SC11JJD 1011r ab6orGent) G:' <br /> 0 <br /> Lu <br /> E <br /> Lu <br /> 2. <br /> w <br /> C7 <br /> Special Handling Instrucbons and Adddional Inforrnatian <br /> ERG VF 171 INi"�s310E }'� pROI tLEtF <br /> WEAR GLUJE; �7 •.Z �{—U[��T�► <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name.and are cinsified.packaged. <br /> marked and labeiedlplacarded,and are in all respects In proper condition for transport according to applicable international and national governmental regulaUons-If export shipment and I am the Primary <br /> Exporter.I cerVy that the contents of this eonsignriwt conform to the terms of the attached EPA Acknowledgment of Consent <br /> 1 I certify that the waste minimizabon slatemeat identified in 40 CFR 282.27(a)(111 am a large quanWy generator)or(b)(if I am a small quantity generator)is true. <br /> 7r`sVer&s;PnniedfTyped Nam�T Stgnawre 11 nlh Day Year <br /> jo <br /> rr <br /> — C— P4 ,�J/ 10-7 118 1 <br /> —j 16.Intemaomat Shipments ❑[.port W U.S ❑Expon from U;S"' Pori of entrylexiC <br /> l Date leave U.S.: <br /> ? Transpoder s gnalure(far exports only): <br /> rr 17.Transporter Admowtedgment of Receipt of Materials <br /> � Tra�e LPd Name Skgnat �I DayS� Year <br /> rr nTnrri 'a 4L57�►C� Lj l <br /> 0 <br /> En T er 2 ledffyped 1�a Signature Month Day Year <br /> G J7 '� 1 <br /> tor.Cliscrnpancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejecron ❑Fuli Rejection <br /> { <br /> ManJest Reference Number <br /> U.S-EPA ID Number80,Alternate Faady(or G mrator) <br /> J_ <br /> V <br /> Facility's Phone. Month Day Year <br /> 18c.Slgnalure of AJtemPaplityale (ar Generator] <br /> a <br /> x <br /> N1g.Hazardous Waste Report Management Method Codes(i e..codes fw hazardous waste treatmenl,disposal,and x:yding systems) <br /> 0 1. 2. 3 4 <br /> 20.Deslgna ed Fadttly Owner or Operator.CWrt fixation of receipt of hazardous malenals covered by the manifest except as need in Item 18a <br /> PrntedfrypedNomel f f Signature Month Day year <br /> C, <br /> DESIGNATED FACILITYTO GENERATOR <br /> EPA Form 8700.22(Rev.12 1TJ Previous editions are obsolele. <br />