Laserfiche WebLink
i <br /> Please print or type.(Form designed for use n elite(12-pitch)typewriter.) <br /> Form Approved.OMB No.2050 0039 <br /> UNIFORM HAZARDOUS 1.Generator Number 2.Page 1 of 3.Erneagency Response Phone 4.M Rest T <br /> %ASTEMANIFEST 16P E <br /> r' 15 JJK <br /> sc gPlmEol'#nldroear,dl gAddress s {iFdiWenta—ffavvaddress) <br /> P 061 3M <br /> tom,CA glna <br /> Gane*es 81Dsilott,�A <br /> &Trwooder 1 NW* U.S.IPA 8)Number <br /> �1tSf6. T.^eK1,r�TIt {�..�d1l�SF+ <br /> 7.Tram;porW 2 Company Name U.S.EPA ID Number <br /> US.EPA 90 <br /> >�S#E.Os�ri R�7 �'A757T8 <br /> '.A OWN <br /> Fac>idysRgrhe:f9fi9�7�a-4� i <br /> 9a. 915•U.S.DOT Description(inckbdmg r SNppklg Name,Hazard Class,b Number, 10.Containers 11.Total 12.Unt 13.Ytaste Codes <br /> HM and Paddng Gmup td any)) ,b Type Quantity WtNol. <br /> 1. pdrk,Fcse,,? { �,-hcu s tke 3A,�c1 <br /> Ccw*DrwVWd DebrK) CM ? 362 �`- <br /> �! �r <br /> x 2. l <br /> W <br /> 3. j <br /> 4. <br /> LL LiT <br /> 14.Special Handling Instructions and Additional rdamation c <br /> #'?j 1 f PIn gs firi',4 FiV.::1 it1)!''njpr4 f i-_Ti l l -- - - <br /> wadr Pmtw P P.G- <br /> 15. GENERATOR'SK*TEROR'S CERTIFIC N: I hereby declare that the contents of this corp rhrrhent are hiy and amrralely described above by the proper sh9ping name,and are dassded,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper cordlim for transport according 4�pppfrcabte eaernatond and national govemmental regulations.if export shipment and I arrejhe Primary <br /> Exporter,I certfy that the contents of this consignment conform to Bre terns of the atadhed FPA Admonledgment of Consent. <br /> I cartity tst the waste mhrhim¢abon sWernerd identified in 40 CFR 28227(a)(4I am a large quantity generator)or(b)(d I am a At q.,bty generator)is tium- <br /> Gerwators/O femrs Prinfed(Typed Name Signature Month Day Year <br /> it" ka <br /> -j 16.Intematlonal Shipments ❑Export kern U.S. P of <br /> F- ❑Impodlto U.S. er"lexit <br /> ? Trenspoltr slgnathrre(for exports only): Date leaving U.S.'. <br /> W 17.TransporterAdmadedgmerdofReceiptofMalerials <br /> Transport yped Name Signature %—.-ate' Month Day Year <br /> VC Z <br /> Transporter 2 PrinWffyped Name _ _ Month Day Year <br /> 18.Discrepancy <br /> 1 as.Discrepancy indication Space ❑Qu1 ❑Type ❑Residue LJ Partial Refection ❑NA Rejection <br /> Manifest Reference Number. <br /> 18b.Ntemafe Family(or GeneralM U.S.FPA ID Number <br /> U <br /> Facilitys Phone: <br /> W 18c.Shgnahn of Alternate Paddy(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous dWaste Report Management Codes(i.e.,codes for hazardous waste beabnerht disposal•and recycling systems) <br /> O 1. 1 i j? 12. 3. 4. <br /> rf +J <br /> 20.Designated Fadhry Owner or Operator tion of receipt of hazardous materials covered by the mantest except as noted in hem 18a <br /> Nnted[Typed Name 1 Signature Month Day Year <br /> -71 <br /> Ll I J-_ki� 10 r I I =fft��' I I I H I <br /> EPA Form 8700-22(Rev.3.05) Pievious editihxrslare obsolete. nl SIGNATEID FACILITY TO GENERATOR <br /> �s <br />