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Pleaserint or <br /> p type-(Form designed for use on elute, 12-pitch)typewriker.) Form Approved.OMB No.2050-4039`.• <br /> UNIFORM HAZARDOUS f.Generator IDN r 2.Page 1 of 3.Emergency Response Phone 4.Manitnt <br /> WASTE MANIFEST 1019'61T317 JJ K <br /> +' i - -7 Y' <br /> &,CeAerato�s Nameand I.1-1. Address — Gefiera (d different than mating address) <br /> P O a@X,33172 )841)1 .Steyr ok"D <br /> rerceraiod'sPfioneNg 41 16.CA 81394 a jty CA MM <br /> B Baosparkr 1 Corr4ary tiaae U.S.EPA ID Number <br /> l tt #�*4 f po{� "•` CA-DM4left <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Desoidod Faaliy Name and Site Address - U.S.EPA ID Number <br /> Z �->�rJ'��iy5� <br /> iiY85x is�klRiTt Rr! <br /> C A 93XA <br /> Faa'6tylsPhone:°` s ?1512'W <br /> 9Ei. 9b.U.S.DOT De5aip6on(including Proper Sft ping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Croup(d-0 <br /> 13.Waste Codes <br /> No- Type Quantity Wt.Nol. <br /> f <br /> 4Z1 2. <br /> 3. <br /> a <br /> _}"' <br /> I <br /> 4. <br /> 14.Special Handling Instructions and Adcitionai Infarn ton <br /> _ E#�G <br /> th"r i✓� <br /> 15. GENERATOR'SICFFEROR'S CERTIFICATION: hereby declare that the contents of this co%ignr wl are fully and aoara'Vy described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in art respc is in proper condition for transport according, applicable international and national governmental regulations.If export shipment and 1 am the Primary <br /> Exporter,I certify that the=dents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified m 40 CFR 262.27(a)(f I am a large quantity generator)or(b)(dl am a smal quanbty generator)is true. <br /> Generators/Offeror,.Pm ted/Typed Name Signature a` /� Month Day Year <br /> -j 16.International Shipments1 <br /> f- El Import to U.S'. ❑Export from U.S. Port of entrylexit —_ _—------- -- - <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TransponerAcfmowtedgmenl of Receipt of Materials <br /> Transportcn 1 Pdnted/Typed Name Signature Month Year <br /> Transporter 2 Printedifyped Name , S gn �� Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy hdication Space Quantity ❑Type 0 Residue ❑Partial Rejection ❑Full Rejedia`t <br /> } 18b.Alternate Facif. or Generator Manifest Reference Number: <br /> F- �y( ) - - U.S.FPA ID Number - -- <br /> J <br /> U <br /> LL Faatity's Phono: <br /> L18c.Signature of Altemate Facility ty(or Genemor) Month Day Year <br /> Q ' <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1 2 �. 3. 4. . <br /> 132 <br /> 20.Designated Facility Owner or Operator.Ceffwliw of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PriwdfTypod Name, - Signature Wnlh D2Y Year <br /> 7 <br /> EPA Form 8700 Z2(Rev.3-05) Previous ekfitioku are obsolete. DESIGNATED FACILITY TO GENERATOR <br /> y I <br />