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4 e <br /> Please print,or, type.,. el . IF. Form Approved. OMB No. 2050-0039 <br /> 1 , Generator ID 2:Pa 1of 3 E cy. ns 4 Manliest TrackingNit ue17— <br /> _ <br /> UNIFORM°H'AZARDOUS � �907 �t : � "; el d � Fel <br /> WASTE MANIFEST _ D=:L: `ZJ ' JJK <br /> e F . <br /> (oYa i e r ss if iifePen than mailin address <br /> �F <br /> it'ei wig " ► o <br /> 1toc Ittan , CA 05906 <br /> 200 941m0682 <br /> Generator's Phone: <br /> 6. Transorter 1 Company Name U.S. EPA ID Number <br /> rMO ROCOVexty OystoW MaeCM000178422 <br /> 7. Transporter 2 Company Name UIS. EPA ID Number <br /> I lid <br /> 8sig6%ft99mjj6%"«s lN ) U.& EPA ID Number <br /> UVWXY 95jP lam . 9 . of Beatty $ RIO * 578 <br /> Beatty , tom► 89093 <br /> iEt1 � 3►# 'E ► + iltfi <br /> Faclltty's,Phone:. <br /> ga• 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12, Unit 13. Waste Codes <br /> HM and Packing Group (if any)) r No. Type Quantity WkNol. <br /> t • >�eatt-��+ �t�tcai�ta>tIE>� �ar`ts�±a qaa tI ;ai.'�v , ., . <br /> Q ;vat" Va lot ) Cr <br /> 3t# <br /> � : . <br /> .�gp 1'� 4 -1 <br /> Ad <br /> Uj <br /> 2• i!Q!•1�Y / pd6Ke"igApi��i+6iaLiteF 89175i , I I <br /> lia1R\P . ,ipy t6.. :,1. <br /> C`) 1 ( 1dBi �t F'' s7 ebal <br /> 1W <br /> ll F <br /> 3. <br /> IL <br /> 4. del <br /> 45 1 <br /> . . . . _. . _ . . . .. . _ .: _ . .. . . .i. . . <br /> 1�. pe° ' '° "a � s ... 1711 OT41' i23**,1302ttt7 29 <br /> '9113 , to VIM Wiwi twopm 8ttM IchlothdJAVI **ft , 0lar t t ! t9 A <br /> t � M9it1iP tk ' 11G � 9IFd3i . #549899 4 , <br /> 15. GENERATOR'S/OFFEROR'3 CERTIFICATION: 1 hereby declare that the contents of this consignment are, fully fully-arid accurately describeP .d above by the proper shipping name, ard,are classified p'a T !<¢ <br /> marked and labeled/placarded, and are in all respects in proper condition for transportaixording to applicablelmtemationaland;national governmental regulations. If.export shipment and I am the Primary <br /> • <br /> Exporter, i certify that the contents of this consignment conform to the terms ofthe attached EPAAcknowledgment of.Consent i. <br /> I certify-that the waste:minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generatF .or) or (b) (Ifl am asma)1 quantity generator ,is.trw. <br /> IF FL . 11 <br /> TEatd . Ys(Offerors rioted yped Name SI r ' Month ' Day - , Year <br /> FkA / bfplek <br /> Fk <br /> 04 <br /> �j 16. International ShIpmdrits <br /> W ❑ import to U.S. El Export from U.S, Port of entry/exit:. <br /> ? Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. TransporterAcknowiedgment of Receipt Materials <br /> Traasp atedGiyped Nam f Signator th^--* Bay Year <br /> wq 3 <br /> zTransporter 2 Printedfryped Name Signature w Month " Day 'Year <br /> �-- <br /> 18. Discrepancy <br /> 18a, Discrepancy Indication Space El Quantity ❑ Type ❑ Residue <br /> O Partial Rejection _ ❑ Full Rejection <br /> Manifest Reference Number: IF , <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> . J <br /> V <br /> LFacility's Phone: <br /> W 18c. Signature ofAltemate Facility (or Generator) L Month Day Year <br /> IC <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes '(i.e.; codes for hazardous waste treatment, disposal, and recycling systems) <br /> G 1 . 2, 3. 4., <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name L , Signature Month Day Year <br /> i <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> _-. . . F ... . . , <br />