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Pjeas�pnntft p:( ori '7gtadt;5se`one�it2rp� hkll+Pewn(ei) <br /> jry `. 1 GeneratorlD umberge Aaof 3 me aA' Res (r�sePhhyena 4 ManHestTfackirlp,Number <br /> SKS <br /> i WASE NP,11N r S ' <br /> i <br /> 6,Generators Name and Mailing Address Gene(at0 s:$lta Address(!f diffetant than inailitig address) <br /> iI DrS A - Go1d(411 t~' 1101f i+ Gate <br /> 15,50. Wok t Stanford Ad Attn SAfteI fthenry 2A 01 St4nftard Rd <br /> TRfiGlyCA 95377 Attn Safety 8AN <br /> Generator's Phone: 09"4 s -3 - TRACY (.l� `.�3�'7�- t-08 <br /> 6.Transrtar 1 Compan N2` a U.S.EPA ID Number <br /> <rt4 INC. TXR t Et i r <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8'..DnFciiitNateg[ $ Addjs. r.U.SEPAID Nom rg . y .. 511F, y <br /> &880 SMITH A0E_ <br /> NNW y CA '94560 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10:Containars.r'' ' 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if.any));- z No. Type . Quantity Wt.Nol. <br /> a <br /> t, <br /> r: � 2'�,tf�'�'.J'';Il```�'�S 1^'t+'F�"�:v't'1��+'�' );14.!l+� �{ *l�r:�.,!"'��'.idl�• gyp,ps.'. <br /> is » ht <br /> , <br /> 4 <br /> t4 Special Handling instructions an Add onalinformation 5 <br /> ..,.�.. .: -v. .-in._y...:ra,;•a;:-a��:.w: •r.:ker.+a»+�+=awea-d�5,r..lcat�.p'^s�� �. .i.. .:,. ._ da*ae"��. '.'�a•?w�.iA+Ydws�xs•daxo`:iut.7i�4.4r:.::.Y_:so-.a...:+...trr +.aoa....._'-se�i,..�, ... <br /> f^'{.N.j`1i3 G�.iSi7l fYCy �P&"'. <br /> 15 EMERA7QR'510FFERaR'SCERTIFICATION: IherebydeGlar@that>i)eConterttsiifttilaoo{t&jgitrt pt'>r . p;aa a ,rOleJyda , ; above.pyif;eRrppetsbipgin�name,andateclassifled;packs <br /> ged, . <br /> rriarketl'and la(ietedlplaoarGed and afa ih all raspectS In propel conditi¢o(orfransporf a'ecording tbapplrCabie fritetnatlonal andn'696'a(' mmental'reg4latlons:If axpott shipment and i am the Primary <br /> Exporter,I ceii(fy that toe contents of 4his consignment confdriir to the tetms.of the attached EPAAdmoypedgment of Consetlt <br /> l certify thattfie waste min imization'statemerit ldantiffoln.40GFR 282.2P e ff(.am.a is a uan'; enerator orb 'd!am a§mal quantity gen ratot)js true.., <br /> (.).(. r9. q . MS 9 . . O <br /> GeneVoedOfferoe!6 Pnntedo..y*Name Sign fy"" Mo th Da� .Y ar. <br /> wj 16 inteniational hpfnents - <br /> FF :c,r lnipnrf t4 U S.. -, L�Jl xportfrom U S Pott of entrylezit <br /> r Zr- <br /> Transporter signature(for exports only):` Date la�Ving.US.. <br /> 17.TransporterAcknovAedgmant of Recelptof.Matedels <br /> �.T nsporter l Printe. Name r nsture Month Day Year <br /> VS <br /> CL <br /> Transportr 2 Print edlTypad Name ignature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quanti ❑Residue <br /> ty ❑Type ❑Partial Rejection .�Full Rejection <br /> anlfestReference Number, <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> � o, <br /> Facility's Phone: <br /> AU <br /> 18c.Signature.of Altemate Facllity(or Generator). Month Day : ear <br /> Q <br /> Z <br /> 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal;aq ecycling systems)` <br /> p 1 € r 2� 3 4: <br /> j <br /> .l s,'ignatadj=of ,Ownert r npeXt3,keii kteYtifidat(br4i((raCefrl rdbtta?.' t (a(s c fefi Ily the mares e$o@pt a5 ndQd in item <br /> nntedFlypad Name ,gyp /}�y Sr0 ttNia.F �lohth Y y Year <br /> EPA Fotm 8700 22 Rev 3 0 Prewouta'editrons are obsolete. �EStGPl4 �D FACILITY TO CaENSRAT ,R <br />