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Please print or type. Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4 Manifest Tracking Number WASTE MANIFEST JJ �u e 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone B.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number fLWA YES�e VMSItz '�,F SAI-Atli', AZIMM62111,48 W os v . Facility's Phone:)',- 9a, hond)'ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. O "AZAR N7 W F =A ISE Z 2. UJ C7 3. 4. 14,Special Handling Instructions and Additional Information 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,aryl 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 EPA Acknowledgment 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)(Ill am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year i 2 16.International Shipments il— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: im 17.Transporter Acknowledgment of Receipt of Materials UJ Transporter 1 Printed/Typed Name Signature Month Day Year 0 Z Transporter 2 Printed/Typed Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number RECEIVED AUG 112020 Facility's Phone: LU 18c,Signature of Alternate Facility(or Generator) Month Day Year Z J- 19. Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Notice: State of California requires 0 1. 2. 3. generator to photocopy and mail to 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a DTSC With 30 days: Printed/Typed Name Signature P.0 Box 400 Sacramento,CA 95812-0400 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY