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Please print or type. <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. Manifest Tracking Number <br />WASTE MANIFEST <br />1 <br />i,ALUIW IWYA11 <br />-; A "661. °a G B F <br />a <br />5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />KALENLI•'i AUTO WKECKINii <br />13237 h HVVY °2..0 <br />8T0C K'i ON, c;A W�2-115 <br />Generator's Phone:_,; . ij` .' 7 <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />rWikkI(;AN VALLk:Y V14ASIf. OIL, IM; CARO0027231J' <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />VV0KLL)WIDE IREGOVERY SYS 1 I-Mti INC: CAf2t70[111 7547. <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />'i'UMA YES L WASTE I1t/ Nt&tK FA01A i X <br />fibOO U5 HCA-NVAY 05 <br />' W365 <br />Facility's Phone: j, , . ,.;., ,jit•. <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />p <br />1. <br />W)f4-KCRA KkZARf tIS MIA TE :17I.i17, Af4 �f)ftBENTS, 411. <br />I <br />IlW1 <br />"•„ <br />;' <br />3S't <br />z <br />2. <br />uu <br />C9 <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />I'RVI ILL# IL1.iti10INIK:i Ht3,1:ul liE 1, AIL kktM 171 <br />LME..R(4I NC Y (X.sN1ACI RAI I'ki <br />15. GENERATOR'SIOFFEROR'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, <br />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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />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. <br />Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br />J <br />16. International Shipments <br />❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: <br />? <br />Transporter signature (for exports only): Date leaving U.S.: <br />IX W <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transpofter�9 Printedffyped Name - A Signature; Month Day Year <br />z <br />Transporter 2 Printedrryped'Name Signature Month Day Year <br />F <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J_ <br />V <br />LL <br />Facility's Phone: <br />LL, <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />Q <br />Z <br />CD19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />cNotice: <br />State of California requires <br />generator to photocopy and mail to <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a DTSC with 30 days: <br />Printed/Typed Name Signature P,0 BOX 400 <br />Sacramento, CA 95812-0400 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />