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�J Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approve , UNIFORM HAZARDOUS 1'Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.thst Trac I bwWASTE MANIFESTA j, tl t7 tl .a 0 4 5 3 9 9 Generators Name and Mailing Address Generator's Site Address(if different than mailing address) 31FE'(l-LIRE 02122 ti `M E KE M EWNN RD I "A rY240 Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number `fPVr'.,_, r A 11 t) /'-1 13 7 1 Ii 3 6- 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated d Facility N{aam�e and Site Address �/�� .^^nn U.S.EPA ID Number "1EMEWS WATER TECHNOI-f. JES CORP WS aOIJTH 9MIE AVEK.IE ,f 1.0'S A�1t)RO, CA ltyl�A 1!11k Facility's Phone: 12,2117- ,2 .- A 1) 1 1 7 U 3 v + '+ j 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 N Wt.Nol. 1. O y7 NC414CRA HAZARDOt1^WASTE, S01.ifs ONLY ABS AHEND I : M I' Z 2. W 3. 4. Special Handling Instructions and Additional Information PROFILE#901 AP16729A CAL t-10 , A8S0R0FNT90'V'e% F'r'r#At 1QfW109 APPROPRIATE PER!CONAL PROTECTIVE Er�J1Pl1+lFNT 15. GENERATOR'S/OFFEROR'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 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 EPAAcknowledgment 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)(if I am a small quantity generator)is true. Generators/Offerors Printed/Typed Name Signature Month Day Year i :: 16.—IRWmtibnal ShiptrlEnts Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O a ZQ Transpo ter 2 Printed/Typed Name Signature Month Day Year F 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_ V LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year t— Q Z Hazardous`Naste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal,and recycling systems) L ., 2. 3 4. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY