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Please print oirtype.(Form designed for use,on elite(12-p Form Approved 01.18 No.2050-0039 <br /> UNIFORM HA.7jkRDOUS'l 1.GeneaW V815294439 1 2.Pagl�of 3. 4.Manifest Tracking Number <br /> WASTEMANIFEST 014057947 JJK <br /> 5.Geiora%r"rtqj8,r,-,WU4nress "+ ,l- t'. '(36eratoesSileAddr2is(if different Than mailing address) <br /> 1648 E. I-VA61PAER LN. <br /> STOCWON CA 95210 <br /> 209 962-8760 <br /> Generators Phone <br /> 6.TransP5-81MMM 01N-M-18WAC SE, It U:S Et 8 2.7', 0'3 6 <br /> A <br /> W1110 <br /> Transporleir 2 Company Name U.S.EPA ID Number <br /> LLC U.S.EPA ID Number <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 9058 CAD097030993 <br /> .(323)277-1500m. <br /> Facility's Phone' <br /> ge. 91b.U.S.DOT Descriplat(including Proper Shipping so, 11,molal'n <br /> - 1,421tUn[t 1 `13.Waste Codes <br /> HM and Packing Group(f any)), No. Type Quantity WtJVol: <br /> 0 <br /> 7V- <br /> Uj <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTRE0 1,$0042"M NAERG#981:171*PROFILE# AP199195 OILY SOLIDS <br /> P590-00P176150 w APPROPRIATEPERSONAL PROTECTIVE EQUIPMENT <br /> -15: GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consilgnment are fully and accurately described above by the proper shipping name,And are classiNd,packaged, <br /> marked and labeled/placarded;and are In all respects In proper condition for transport according to applicable Internal2onal and narional governmental regulations.It export sh�ment And I am the Primary <br /> Ekpo.rier,I certify that.the contents of[his consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste miniml7allon slatement Identified 040 CFR 262.27(a)(if larr.a large quantity generator)or(b)(41 Am a small quantity generator)Is 1-rue. <br /> paneratoes/Offerces Printedrryped Name Signature Month Day ear <br /> Import io"U.S., El awl from U.S. Port of entry/exit: <br /> 16.International Shipments. E <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> ce 17.TrangoorterAcknowledgment.of,�eceI I of Materials <br /> Uj I . p <br /> Tran;Mer 1 Prinle <br /> Sil;nature Month- Day <br /> 0. <br /> z Transporter.2 Printedf"Typed Name Signature Month Day r Year <br /> 8.Discrepancy <br /> Be.,["' I di Space ,n E]Full Rejotioni <br /> PIS Parq� election <br /> Vie <br /> q1, - -r - , <br /> �y� 1�., <br /> OTY <br /> -Manifest Relerence Number. <br /> Seib.Alternate Facillity(or,Generator) U.S.EPA ID Number <br /> =3 <br /> u- Facility's Phone: <br /> Lo Month Day Year <br /> 18c.Signature of Alternate Facility(or Generator)U <br /> Z <br /> 10.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste tmatment,disposal,and recycling systems) <br /> LAI1. 2. 4.7 <br /> 20,Designated Facili ty'Owneror Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Name Signature Month Day ear <br /> Printed(Typed Nair <br /> 5 <br /> EPA Form 8700-22(Rev.3-05) Previous editionts aie obsolete. TRANSPORTER'S c6pe <br />