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Please print or typo. Form designed for use on oils12-pltch)ty Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Ggnera IDN bar 2.nage 1 of s.Emergenry Response on 4 M.nnest Tracking Number C <br /> WASTE MANIFEST �_AL0f)e.' �F005759343 <br /> 421 y (�i3Gf.+ "!`*(�$at F�„E <br /> 5.Generator's Name and Melling rase 'enerators Site Address(if ciftrent Wen mailing address) <br /> 7 N Ei Dw ado St, 7906 N� Ef 00redo St <br /> tac*tor�l, CA 211 s + ;Qi'3•t �3 3 `�#>� ;#alt; �.� 1 � <br /> Generators Phone: a <br /> b rensporter party Name U.S.EPA ID Number <br /> T.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Address U.S.EPA ID Number <br /> US <br /> Nevado er )dos <br /> I"i)g"aaya, 12 Meg Es I�f , V'r,j3ir� t,a, <br /> FRq s%ohs V 82M � �It 7T'�'1 #"s-��;� <br /> ga. 9b.U.S.DOT Descrlptlon(Including Proper Stripping Name,Hazard Clam.ID Number, 10.Containers ti.Total 12.Unit 1 f Waste Claes <br /> HM and Packing Group(if any)) N0. Type Quantity WWI. <br /> O � � <br /> x 2. <br /> 3. <br /> 4, <br /> 14.Special Handling in udiona and Additional In formation i <br /> �:RC* 171 r�ta,Sayr+Ds , Hca"sf„FIR*rls aINto A�F_AR PPPCf�f IAT . F".31..x' 946 <br /> MiSO 001!64 kyr ntatls'Y111'Iate d� t4~ Gwi afin* -'E► 30NkL f'r%r-fJL_'L"F`WE <br /> r'L0T),41NG <br /> 15. GENERATOR'yaOFFEROR'S CERTIFICA ; I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged, <br /> marded and IabeleNplacarded,and are In all ospects In proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter.I pettIfy that the contents of this eDrisignmeni conform to the temps of the attached EPAAckrwwledgment of Consent. <br /> I Certify Wet the waste minimization statement Identlfled In 40 CFR 262,27(a){d I am a large quantlty generator)or(b)(d I am a small Quantity generator)Is true. <br /> �enera6i'siOliferoeD Printeorryped Nam Signature tMy yew <br /> u 16.Intematlonel Shipment, <br /> F ❑Impoto U.S. ❑Export from U.S. of entryiexit <br /> z Tran r lure fore rte only): `� Y+Date leaving U S.: <br /> 17.Transporter A&mwledgmenl of Receipt Of Materials <br /> Transporter I P40.tedfTy_pe_d Name Signature ti n ay ear <br /> �. <br /> Transporter 2 Prin am Month Day ser <br /> fY <br /> 18.Discrepancy <br /> 18a Nsaepancy hrdicat on$pace Qua Ifily Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternans Faculty(Or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> FK!tys Phone: <br /> dFd 1Bc.Signalure0(Alternate Facility 0Generator) Month Day Year <br /> Z <br /> 1 19.Hazardous Waste Report Management Mod+od Codas(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1 2. 3. 4. <br /> rPn <br /> Designrelad Faoility Owner or Operator Cott on of receipt of hazardous materiels covered by the manifest except as noted in Item 18s <br /> t pati Name Signature Month ay Year <br /> EPA Frim$700-22(Rev,3.05) Previous aditiortal are obsolete. GENERATOR'S INITIAL COPY <br />