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ase print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 14. Manifest Tracking Number WASTE MANIFEST CAL. 000 3 g (A 2°r t L 3 �ZtoA 11 0 0 3 7 4 11110 3 5 G B F 5. Gen tors Name and Ma1irigAddress Generators Site Address (if different than mailing address) CjR , ag 1 *mw % �vkxiu.�clka t tZ O� S tiP Ipl # 1 e t) S 1st r� ttl p �-5� - tv0v 10 ► S W - �� t A e; Generators Phone: Z4 9 6. Transporter 1 Company Name U.S. EPA ID Number N 6J V kewm(= A. '� �tc,as I ►JC • GIA+2400b 3a 11 �{ 7. Transerg Company Name w ` U.S. EPA ID Number l 8. �q est Fad ny am and ite dres E U.S. EPA ID Number 209 S N �1rJ S D12.. � UNI ►`�'� ug NV D 9 IS33 Fadlitl/s,PtKKle: ga 9b. U.S. DOT Descrdption (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Total 12, Unit HM and Packing Group (d any)) No. Type Quantity yyt,rycl, 13. Waste Codes o ', r 001 C�= 260 C saw a , o�� gl 2, LIN 14111 WiAesmOAtm e-)M b / oo . s . � 00 k DF O1S { $ 1 3. ` , i \ Iga3, Vel ( �ptMMAbt� tau S, , 1CI60 4. ing n ns and itional 4. 1'U I�tLBIdLSPcfJ�t-(3 , iso - fit S � AF, 3402340230q S 3 -cry C �c 1 15. GENERATOR'SIOFFEROWS CERTIFICATION: I hereby dedam that the contents of this consignment are fully and accurately described above by the proper shipping name, and are cassdJ&};packaged, marked and labeledloacarded, and are In all respects in proper condition for transport according to applicable Intematlonat and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this oonsignment conform to the terns of the attached EPAAcknowledgment of Consent. I certify that the waste minimization sta menti tiW in 40 CFR 2.62.27 a) (if l rge quantity generator) or (b) (di am a small quantity generator) is true. nerator's/Ofierors Prihted/ryped Name 3 Month Da Year t 4. �ccl'w r ctt 12r 3�t —,t 16. Intemational Shipments F ❑ import to U.S. ❑ Export from U.S. Port of entry/exit: ZZ Transporter signature (for exports only): Date leaving U.S.: 17. of Receipt of Materials ui F Transporter 1 PrintedlTyped Name Signature Month Day Year a- Q Tran 2 P 0 ted/Typed Signatu Month Day Y F 18, Discrepancy 18a, Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Refection Manifest Reference Number: 18b, Aftemate Facility (or Generator) U.S. EPA1D Number V uQ FacilVs Phone: C3 18c. Signature of Altemate Facility (or Ggnerator) Month Day Year Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1 . , t 2. ©WI 0 21, Deslgnated�iF—acciliity Owner or Operator. Certification of receipt of hazardous materials covered by the maWest except as noted in Item 18a Month yyjt?yl 0A I W EPA Form 700-22 ev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)