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----- T, ►SSL - <br /> I0 -31r- 11) <br /> 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 TrackilNumber <br /> WASTE MANIFEST CAR0011285932 (877) 577- 2661 ' 00 02 7682 DAT <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CITY fI 1 ccMY4 StI'I!G TRACY fRILITY CITY on L'iNI f OF SFPK.Tk%Y FI}1,`ILITY <br /> .1390 NRKF-f STI-ET. SIE 216 quou VEST VIEURLIS too <br /> Cl" Generators Phone: SPA FRUI5CO CA 14'I#? (415JIM W T MY V) '35,317 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> aTF IRICYCL.E Sf'ECTAUY WASTE '34l. UTIONS INC. PIRS10003^10924 + <br /> 7.Transpo pr2 Company Name <br /> 7 UP ! ID Number <br /> C <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number y <br /> FkA ft,= =ON LLC 101 PSI„ B.VIRG 47 419L SERVICES <br /> 11851 Yhite Rack 18aN <br /> Facility's Phone: M13 C6;~TOR, CR ISM (3151 351-133 CAD9808I:I4183 <br /> ga 96.U.S.DOT.Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total °,12.Unit <br /> HM and Packing.Group(if any)) No. Type Quantity WfNol. 13.Waste Codes <br /> 1. PC C-:r 1.' 'S 1 t 4111 52 <br /> o lZ P <br /> 001 a r <br /> 10/$ QI <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> €i1 98I; Rt-11tI ISN <br /> PCI CIpicATUIrS U) RCCCSFPAINLP-02 Fly U@) MOOD OIL 0% <br /> .15:-.GENERATORISlOFFERORS-CERTIFICATION:-1,hereby declare that the-conten!sof this oonsignmentare fully-and-accuratelyAescribed above.-by-the-Koper shipping.nam e;arrf:areclassified,gackagedr — <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 EPAAcknowledgmentof 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 tor)is true. <br /> Generators/Offerp( Prinigd yped t me ,� Signature — Month Day Year. <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export from U - <br /> .S. rt of entrylexIt: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> #-- Transporter 1 Printed/Typed Name Signature ✓ Month Day Year I <br /> Z Transporter 2 Printed/Typed Name Sigrre `� ; Month Day Year <br /> Al <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity's*' ❑Type ❑Residue' ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 05 19:Hazardous Waste Report Management Method•Codes(i:a.,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 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 Namer rn Signature r Month. Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. ( DESIGNATED FACILITYTO GENERATOR <br />