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• is ,• --. <br /> Please pnnCor ijtpt: Form Approved.OMB No.2050.0039 <br /> 1:711111 7T <br /> UNIFORKHAZARDOU$ 1.Generafor lD Num6Qr t r 1 2 Pagel of G Esperge:sy R pd se Pha a 4.MamfestTracking Number. <br /> WASTE MANIFESTGBF <br /> a : (� (�J '' as <br /> 5.GeneraloPs_Name and Mailing'Address fr ya .GeperatorsS�teAddress'(ftdifferentthan matting address) <br /> •, ` K��F r��:i�I�Pa`I�� : <br /> Generators Phony <br /> 6.Transporter 1 CompanyName. 771 <br /> U.S:EPA ID Number <br /> 7.Transpoiter 2.Company Name U:$.EPA ID Number ' <br /> Tr!~!r;!u1,1 � 'IMr1l f`r•VVy!'1Ttr^.a51tD113fd;s�I!!EG €ihr�;.fUl1 t?'�'^! <br /> 13..Deslgnaled Facility Name and Site Address Grp y ILS:EPA tD Numtier <br /> w, <br /> ��t��+°tlF11l'1�R�?(yAt t�il�. ..'; > '':,. r' • , .. A;Uf~f3€t#3at,��£,;,.- . <br /> RANCHO'C(1F#0C39IJt.,SLA_95742 .' •. .. <br /> FacilitysPhone;3'€oi <br /> 98. t3b:U.S.DOT Description(including Proper Shipping Name Hazard Class,ID:Numbe.r, 10:Containers 11..Tow 12.Unit <br /> HM . and Packing Group(if any)) 13.Waste Godes <br /> tr <br /> 1. ` No. Type: Quantity. .Wt.Nol <br /> o: R(4i.,l Nle 9:? `uVr'sSVE",f=i..AMAPIA Bl E Ic UIE)S �. j— ,� � . .. <br /> g s,fN�a elf t >? aaz,t.3;:pC {i, Ji. i15 { f.t El I t�G I <br /> 3. �q <br /> __ <br /> 4, <br /> 14:Special Handling Instructions and Additional lnf6rmafiore <br /> i ; F tL:t" f�t;S4:3F_i7_f i AOI,: -)6AS <br /> cc*rfAbTt CRAIG <br /> 15. GENERATOR•S/OFFEROR`S:CERTIFICATION I,hereby.dedare!hist the r�nterfls of this consignment;ere Jull�and accur�telyi descritfetl:abovh the rd ershi'€n name and aie classified <br /> Y. 9 ,packaged, <br /> marked and labeled/placarded;and:are'm 611 respecls In proper bond Ubn forlragspprt according.to.applicabla lriternatiohbiand "11"I"oveiRmehfat regulations.If ezp6rkslif rnenl and.i;am the Pr€ma <br /> ExPorter,lceriity:thatthe.contents'oflht5consighmentconrotrpfocheaermsoflhA:e¢QchetltPAAcknoivlt gpteotofCbnsent ry <br /> '[4 <br /> P <br /> €certifylhal ihe.v7asle mimmfzaiion stalemen(idenbfie. iii'90 CFR 262;27(a);(iP,larf h 1Qrge guatj(€ty gQnerator)or(bj(if I am a smaiFquadIih genera(or).is tiue: <br /> Gegeraior�lt)ft$rors PrinledlTyped Jamey r r( y€r c L Vii_. ai`� tt{+ Si �ulQl ! Month Day Year <br /> td"i�e <br /> 16;Internationalhlpments <br /> .jw <br /> s— ❑Import to U:S. ❑ESpott ft`om tl S: Pert of en4lkit <br /> Z .'Transporter signature(for exports only): Data,.leaying U.S...._ ' <br /> W 17.Transpo0,;ckno ddgniant of Receipt 6f Mater ais <br /> �, Transporterr{I P'n)etlrT ped N e ' <br /> X' r^ ,/l 9laahr �` "`'"�. lulOR Day Year. <br /> t <br /> qtr E" t, ){�.,�•E".' -a' Y�`. H` <br /> ,Traospbrter2 PrintedlTypel Name 3tgoalura F- -Mdnlh '" Dj Yep } <br /> Ae <br /> VW <br /> 18.Discrepancy 7 <br /> .J <br /> 18a.Discrepancy Indication$Pace:'' ❑ Quantic ❑T a ❑Residue <br /> y YR„ ❑Partial Rejection ❑Full Rejection <br /> -Man <br /> Reference Number.. _ <br /> 18b.Alternate Facility(or-Generator) U.S.EPA ID'Number <br /> U <br /> Facilily's Phone: <br /> 18c:Signature of Alternate Facility(or Generator) Month ' Day Year. <br /> '19:Haza(dous,Waste Report Management Method;Codes(€a,:godej�(gr, dpus waste irealment,dlsposaf and recycling systems), <br /> � Ye <br /> 20:Designated Facility Owngi or bperaloy Certification of recelpt'6jha tdpusmQtery s covered Dythe mantfesl excePkaB ;e wJs)(trs i:tsa <br /> �• '` � Mohth :Da Year <br /> Signaltire �y j y <br /> P[in(.edfTypen Name t ,^. 1, �W��} ,��r��� , y✓ J`�'�<�' r S i f' <br /> .!` 1 5 r:•tii i rx?„L�,.`.+''� d r t Y' •^"`"'�S '.'�,"'-'w' - 1,r+"� j - <br /> EPA Form 8700-22(Rev.'12-47) Prevloas edlllons are'obsoiete Cr °•` ' �'y`I 7 t:i° �c �5 YGIL(T° I a1(�'�t.:(; , c.t. <br />