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I•,"„t111Noll INMi l <br /> ase print or type.{Form designed for use on elite{12•pitch}typewr ter.} F I-,i- -, Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone e.Manifest Tracking Number <br /> WASTE MANIFEST 008631598 FLE <br /> S.Generalor's Name and II&Iing Addf>•ss Generators Site Address pt different than mailing address) <br /> SCrr €.C12.113 ?rli-l. ',T€FC'i `'&,O NCRT!-I i-€RIN STREET <br /> Generators Phone: V!411 CA 753-%-•3900 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> i :r'1CV,.lt r'I],•"1 x11 " I r .1; Ss 1Ut1 r1n LLC 1 -rfi T G 1.1 lf <br /> I.1, _� '-:)P4 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> r <br /> / Ir�lrG+r'olpCr� � <br /> B.Designated FacilityNam(end tt dress til'�.1 i r O n c%,kt-ai (i+,) ,I LLC ' U.S.EPA ID Number <br /> Rack RUZ`1 <br /> Rancho Cordcv-s, Ct'1 3--17,� <br /> I Facdit)es Phone:916351 @985 IGRD9858a4laz <br /> II ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers11 Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity WtNol. <br /> X billi,-q 53pr- s" <br /> , Llat ,ir so16; fIala--jable 2, 1P; : <br /> , G; t?6 1 DF 110933 p -7-'!0 <br /> W <br /> W -Nun RRA hate..,'doua wa,3ty, liquid (Cr:n:40.Ie11 2Dr r=0377 r. 3:i <br /> Consui.l=r E.'%L,: tronic� for Recycling (E;PnLrul E- 1 C 600% P it11 <br /> Waste; <br /> 4. <br /> 14.Special Handling Instructions and Additional Information r <br /> i� .tiG3fltgVroi;,l:,; 2. 11T5?4{P1nrI-;ICR'A I_igttid 4!az�t+r• tGR Clrtly) <br /> Lou,--apac(,] ?, 1105431lCon,_wirC - Elect r oaik.-: for Rec;'cl ingi <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 tabeledlplacarded,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,t certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste miNnnizatior statement identified In 40 CFR 262.27(a)(if 1 am a large quantity generatorlor-(b)jf I a`m a small quantity gen�eptorjiSTNe� <br /> Generator' erors Pnntedflviced Nara sign a /� ! Monty ay Year <br /> \t' to SC r <br /> -j 16.International ShipmentsI.– ❑Import to U.S. J ❑Export from U.S. �d of entry/exit: <br /> Transporter signature(for exports Date leaving U.S.' <br /> W 17.TransporterAd rowriedgment of Receipt of Materials <br /> Transporter 1 �Name Signalure Month Day II Year <br /> Z T iter 2 P'nteayped Name Signature on 07 ear <br /> 18.DiscreMncy 'f <br /> 18a.Discrepancy Indication Space QuantityType El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Facility's Phone: <br /> LL, 18c.Signature of Xtemate Facility(or aerator) Month Day Year <br /> a I <br /> z <br /> N19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 y-1 (L j f 2 3. H 1` . 1 <br /> 4. <br /> 20,Designated€Faality Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Iter21'18a "I <br /> Pnn`e Name� " � !� � / I Signature �,l / Month Day Year <br /> EPA Form 5700-22(Rev.3-05) Previous editions are obsolete. dESIG,!E:i ED FACILITY TO cr ORATOR STATE(IF REQUIRED) <br /> I <br />