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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 ResponsePhone 4. Manifest Tracking Number t :: WASTE MANIFEST hR,000785262 � 0ft 021067819 JJK 5, , apeJtotr's �tpe .ar�dillnddre ¢ i UMS Generators Site Address (if different than mailing address) t 1.225 EL PZNAL IIRTHF: j T0Cit'MX , CA 95205 Generators Phone: I t A FtQ "t , _4111 6. Transporter 1 Company Name U .S. EPA ID Number '�:Lt f<;zFAAA HASARDOIIS i�AS; E REIt" VAL YSC D51 �3Z45� 23 �J �1 7, Transporter 2 Company Name U .S. EPA ID Number E.1 LW ' III " t . ':;a . '€ # ' ' .+i4 0001- 94217 8, Designated Facility Name and Site Address U.S. EPA ID Number Jt: id IXC:O un 2 irZE$ f 'SAA PADLO 1VCATE E4C Facility's Phone: 6 :19 — 270 -, 9463 �i:. .4 "1 t9G 1- 90113 .1 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. a : _ p t Z 2. w C7 3. 4. 14 , Special Handlinq Instructions and Additional Information , `I �� z ork. IAAAky JE ,&k .►6°i'9:..faRECYCLENG Twr�' .. 020526 / 10E / 180 020539AGE: 11i8 , 0205 -.41199/ 16 AC RO # 15106 1 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, and are classified, packaged , marked and labeled/placarded , and are in all respects in proper condition for transport according to applicable intemational 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) (ifl am a small quantity generator) is true. Generator's/Offerors Printed/Typed Name Signature Month Day Year r 16. International Shipments ❑ Import to U .S. ❑ Export from U.S. Port of entrylexit: ? Transporter signature (for exports only): Date leaving U .S.: W 17. Transporter Acknowledgment of Receipt of Materials LLI Transporter 1 Printed/Typed Name Signature .> Month Day Year o _ . � . N Mbnth DayYear Z Tr sporter 2 Printedrryped Name Signature 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 J C) LL Facility's Phone: U 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z C7 14 Haxardnus Waste ReportManaaement Method Codes (i .e. , codes for hazardous waste treatment, disposal , and recycling systems)