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Please print or type.(Form designed for use on elite(1 -pitch)typewriter) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Numbei 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST L O Q � 3 -b g(0 T03— 000257466 M W I 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) �LoGAL M-ATEK1A NA-r4AC-i CMCA1r Lu t640, N, f3KoAD�iftVCi SV0CJ-1TA/ Generators Phone at 0 3 — 6` 6.Transporter 1 Company Name U.S.EPA ID Number LL lTom -HAUL 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number CLC-AtQ 13()U 25'00 W /Lo b C-T- Lg tj I QU•TT0MI J(LL01J,CA CJ22 , Facility's Phone: - 6 y�D CA D9 0 6-+ 5 2-b ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit and Packing Group d an 13 Waste Codes HM 9 P 1 Y)) No. Type Quantity Wf.No,. Z O 1lZ . S - —— ---- - I�1oN-��A H Z/tt us w-As•rF) SOLID t)0 ) Cay 2(5 Z 2. W 3. 4. 14.Special Handling Instructions and Additional Informati n 1Ll il�' C.H 1 3s 2-1r-8 V S P R-0 P L-d"'- V Pe 15 GEN ERATOR'SIOFFEROR'S CERTIFICATION:I r ereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledrplacarded,and are in all respec s in proper condition for transport accerdicg to appi cable internalional and national govemmental regulations.If export shipment and I am the Pnmary Exporter,I certify that the contents of this consignmE nt conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identii led in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneraloeslOfferors Pnntedfryped Name Signature Month Day Year 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexlb Transporter signature(for exports only): Date leaving U.S.: W 17 Transporter Acknowledgment of Receipt of Materials Ce Transporter 1 Printedfryped Name Signature Month Day Year O a Q Transporter 2 Printed/Typed Name Signature Month Day Year r 18.Discrepancy f� 18a.Discrepancy Indication Space Quari ❑Type ❑Resdue C Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J FacTty's Phone. L 18c.Signature of Altemale Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Code (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2, 7-- . 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PnntedfTyped ame Signature Month Day Year 3A Form 8700.22(Rev.3-05) Previous editions are o�solete. DESIGNATED FACILITY Tr)nPCrrnrATrnnr C•rA-117 [Ir—�., •,