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mease print or type. Form Approved.OMB No.2050-0039 <br /> i UNIFORM HAZARDOUS 1.Generator ID Number. 2.Paga l of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR000285262 1. '' ���-sea-3e78 021067819 JJ K <br /> 5.Generator's Name and Mailin Address Generator's Site Address(if different than mailing address) <br /> KETAL FINISHI�G SOLUTIONS - sTUCWM]ff <br /> 1325 EL PINAL DRIVE <br /> STI)CRTON, CA 95205 <br /> Generator's Phone: 9 1 A RC-4-4711 <br /> 6.Transporter)Company Name U.S.EPA ID Number <br /> AM,— r-REMVAr--TNC ICAD9&2$973$9 <br /> 7.Transporte 2 Company Name U.S.EPA ID Number <br /> VERY RECYCLING, INC- CAR000194217 <br /> BRDEsignatCe;Facili NRaAme and Site RRr Y DE <br /> �XI� U.S.EPA ID Number <br /> CARRETERA- FEDERAL NO. 2 HEX, SAN PA15LO TECATE 15C <br /> Facility's Phone: 619-270-94,93 MXC130619001 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1.KV, r r r f�fFfp 2 1 <br /> O g PG-II "( <br /> �7 5 <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> i <br /> 14.Special Handling Instructions and Additional Information ry <br /> 1) 819-26973 DEOY ALUICNM x r 7 9 Z <br /> PRYMARY EXPORTER: TFMARRY RECYCLING INC- 020526/10E/18, 020539/10E/18, 020514/9E/18 <br /> AC PO# 15106-1 <br /> 15. GENERATORVOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signature J Mont Day Year <br /> International Shipments {{-� <br /> -LJ Import to U.S. ''.',� Export from U.S. Port ofentry/exit: Q Iq <br /> z Transporter signature(for exports only): /"!� Date leaving U.S.: 3 <br /> UJ 17.Transporter Acknowledgment of Receipt of Materials <br /> ranEr er 1 P'ntedlTyped Name Signature Month Day Year <br /> vt VQ,Z. <br /> CL , <br /> Z T nsporter 2 P$ted/Typed me nature / <br /> Q 9 nth Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br />' U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1. 2. 3. 4. <br /> 1 <br /> i' <br /> 20.Designated Facility Owner or Operator:Certification,of receipt of hazardous materials covered by the manifest except as nd d in Item 18a <br /> Printedmy�edlName h\ t/ Signature Month IDay Yea <br /> 1r <br /> EPA Form 8700-22(Rev.12-17 1 Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br /> � <br />