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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) ' Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generates ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest TracId Number WASTE MANIFEST �� r h►; _.Lt.�ti.;~,; 0 0 4 5�3 5 9 7 4 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) -O FrulBE Jrrn? r 0 E. KE"rl'(.FMa.N RD !.i CA CA. �f,240 Generators Phone: r 6.Transporter 1 Company Name U.S.EPA ID Number A�� I I '1' 'N11 A(�P.IIt I1'(k! r;t R��!`_c % h C� q 2 13 +; 7.Transporter 2 Company Name k U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number ^IF.Nf-N`:WATER TEGHNOLO,.AFS'WRP ?375 SOUTH B Y;'LE YWENILIE J LOIR AWDELES CA `fit-43i'Y.31� A 17 +i A 7 U L; t, 3 Facility's Phone: ' " iF 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 Pacing Group(if any)) No. Type Quantity WLNol. 1. � Y7 N(+ RCRA HAZARi)al"'WASTE, `OLID(OILY ABS MJENTI i� E M F, z 2. LU c� 3. 4. Special Handling Instmctions and Additional Information PROHLE X 81 .AP 1131729 i OIL 1.10%, .ABSORBENT%.``�:�°Pt"1#Al ICS;A 19-APPROPRIATE PEW011k PPO TECTI�k- C-QUIPWNT 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 dassified,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 ConsenL I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(if I am a small quantity generator)is true. [G5enerat7-Vs/Cifferoes Printed/Typed Name Signature Month Day Year ,' r^ r 16.Irltemational Shirrients U— I— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O n QTransporter 2 Printed/TWed Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Spacer ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number J V u- Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z '4.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. T-- 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(ryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY