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Please print or type.(Form designed for use on ON (12-0tch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Nu r 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 000 4 :4 314 15(o,---f 03- 1 000257466 M W I 5.Generator's Name and Mai'ing AddressGenerators Site Address(if different than mailing address) �LoQAL MATC L M�Aq - -'1JTLL-C, f64o, N• r31<oAPej Generators Phone: Cci0 -- cl C--A -9 S--7-0 I - 'T C C lJ A),, C.Transponer 1 Conpeny Name U.S.EPA ID Number L L I To N -[4 u t� 7.Transporter 2 Company Name U S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number CLC-Ali Rp 2ToO W LO E� j QU7Tant►JILLa�1,(fl 93za�, Facility's Phor.e: 6-6 -b - 6 �-�`� a.A D9 &'0 6 4,5 2.b 5 ga 9b.U.S.DOT Description(including Proper S lipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12.Unit HM and Packing Group(if any)) No. Type y 13 Waste Codes y Quantity NJt.No'. 1. "Z-N-XIUs W-ASTF,, S O L l0 lbo I Cly 2-0 Y Z 2. W 3. 4. 14.Special Handl;ng Instructions and Additional Inform ition �iZO l L l * C-1iI Li IS L I S$ V S � PRI-0 PCS pPC 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are ful!y and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledrplacarded,and are in all res cls in proper condition for transport accordicg to applicable international and national govemmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consign nt conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement ide 8fied in 40 CFR 26227(a)(if I am a large quantity generator)or(b)tiff am a small quantity generator)is We. Generators/Offerors Printed/Typed Name Signature Month Day Year j ,/L 16.International Shipments El Import to u. . ❑Export from U S. Port of entrylexit jransporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materals'i Transporter 1 PdntedlTyped Name Signature Month Day Year O a QTransporter 2 PdnledfTyped Name Signature Morlh Day Year r 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quanlity ❑Type ❑Res due EiPartial Rejection ❑Full RqW., Manifest Reference Number: 18b.Alternate Faciiiy(or Generator) U.S.EPA ID Number LL Facliy's Phone. y 18c,Signature of Alemate Facility(or Generator) Month Day Year z n19.Hazardous Waste Report Management Method Cads(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Ll 1. 2. 4. 20 Designated Facility Owner or Operator:Certification f receipt of hazardous materials covered by'.he manifest except as noted in Item 18a PnntedfTyped Name Signature Month Day Yeer 3A Form 8700-22(Rev.3-05) Previous editions are bsolete. DESIGNATED FACILITY TO nFCTlnteTlni eTAre rrr-I--��•�• ••••