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f Please 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 4.Manifest Tracking Number WASTE MANIFEST JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) kJnknown OW9 c A,..", :ar.::rrn GtO DTSC P.G. Brix811f] 9"1i tc,rafwye Ft:1�t�t 2rrif�,a„�v +?..3,! ::acram�snto.CA 9661'i Stockton GA 9521 + Generator's Phone: 600-700.39 _130 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number Stemircle'3pizciaRyVia 1p G'0 Arms Inc f tJF-'KN)1 Infr4 8.Designated Facility Name and Site Address U.S.EPA ID Number a11()-CHFJA, LL(: 4'2'd Isis Avory CAGt1U83G44:t.' irroewcnd.CA 90301 Facility's Phone: • ,=., -ii 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 Wt.Nol. 1. o 11N2811.Toxic Sohft.Orgaimc,N S ,(Haze-a!).8 1.PG II z 2. L C9 3. 4. 14.Special Handling Instructions and Additional Information ERM!154 ERG Book in Vriucw Wear aopr(Kxiate PPE when hancitrnt) 1(1�'i1 jr>t;1�3t?85 d R �'h cFti">R t tt•f;fs-Ofl�, 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,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 1 am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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. Generator's/Offeror's Printed/Typed Name Signature Month Day Year -J 16.International Shipments F. ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z 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 is Z Transporter 2 Printed/Typed Name Signature Month Day Year a 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 U �a+ Facility's Phone: - 11 LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. F 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