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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 F15.UNIFORM HAZARDOUS enerator umber 2.Page 1 of 3 Emergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST Generator's Name and Mailing Address _ Generator's Site Address(if different than mailing address) JJ K 800 GRANTLINE RD Generators Phone: TRACY 6.Transporter 1 Company Name U.S.EPA ID Number 7036 7.Transporter 2 Company Name U.S.EPA ID Number -100'LfAMD F?1?t:t)V.i'r'SY` !'s!:i ilii ` A R 0 0 0.1.7 5 4 4 2 B.Designated Facility Name and Site Address U.S.EPA ID Number 6500 US I-if l'I4++AY 95 Facility's Phone: to-)0 5 2 11.4 6 9a. 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1. i...�....'s":''ASTE.: O _ _ W 3. - f 4. 14.Special Handling Instructions and Additional Information MERG.NV CONTACT:CHEIVITREC 1-800,424-9.300 WOES TER AINAI.:CERES CS NAERG#981. 171 *PR IFIL`:P 9PI 1.6262MRSNIX002 OILY 9131-11D. PAPER FLTERS * *APPROPRIATE:PPE BlUITIMENT 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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I 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. Generator's/Offerors Printecirryped Name Signature Month Day Year J 16.International Shipments I.— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: K Transporter signature(for exports only): Date leaving U.S.: w 17.TransporterAcknowledgmenl of Receipt of Materials t2 Transporter 1 Printed/Typed Name Signature Month Day Year O Q Transporter 2 PrinledlTyped Name Signature Month Day Year H 18.Discrepancy 1Ba.Discrepancy Indication Space ❑ Quantity ❑T e yp El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.ARemale Facility(or Generator) U.S.EPA ID Number J U ra Facility's Phone: H18c.Signature ofAllemale Facility(or Generator) Month Day Year R Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. Ll20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Name Signature Month Day Year I I I I I EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY