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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C�AR0002FC526 1 1108-.163 - 678 FLE <br /> 5.Generator's Name and Mailin Address Generator's Site Address(if different than mailing address) <br /> METAL �'SN]:SISi.�lytlf, SOLUT:1 ING - 9T(3CIi'r0N <br /> 1,325 1E11 P MAL D fw <br /> sT'CrC1tTEl4C, <br /> CA 952 5 <br /> Generator's Phone: 43 -4 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ,RVI REC::VC1i.,TW;, . VC- <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desiggnoted Facilityty�Name and Site Address U.S.EPA ID Number <br /> )�'Ft'iE,'F.Pxi)f1iiF tRY LIE 11F'x1C0 <br /> CARRE' CRA F!1:D; x'#L NOL 2. VIE-1, SAN E►Fin-U) f'EC",A'C"F <br /> Facility's Phone: <br /> 9a. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> W D002 t35 <br /> T�id!�fclPar°yVIC, X-0.S . , 8, PG 11 M11171)ROGE Y r'tj Ki <br /> 1tr-XAEL(ift.?RirfT1.11`AKATE, A"'.7A:)N'CM KTORMEN t <br /> IP LUOR]CDL) <br /> 3. KQ, t� A-YAV 03 .-t.• ft, Lu ..C.., � !3 4_% <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 2) 1V'201,196-7 SPENT GARDOWD D <br /> 0 ^3.9-26912 CAkxST'M CLEANER ��It7�i�� ({� 51LI, 'LJ ALL C LEA 11 17047 µ "FS V0# 1327 <br /> PR:fltM,y EXPOP'rER TT~RY E4•. .C1t°k-L' TNG INC- 0726074/91E?°20, 02607519E,/20 02521677' E:,`7sE <br /> 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,arca are classified,packaged, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br /> 16.International Shipments <br /> ❑Import to U.S. n <br /> ❑Export from U.S.- Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> F Trans orter 1,.Printe ped Name Signature <br /> ' i 9 Month Day Year <br /> N �• `r <br /> QTransporter 2 PrintedfTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> H 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> C3 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 01. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />