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Please print o'r6,pe.(Fol designed far use on elite(12-pitch)typewdtec) <br /> UNIFORM HAZARDOUS 1.Generator ID Number Form Approved.OMB No.20500039 <br /> 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tra-c]kin Ntu�mher <br /> 'WAll MANIFEST y A - Q 2 O O 7 3 3 3 9 7 <br /> 5.UtIne ators Name and MeilingAameas 7 7 S 7 8 + 800 4213030 F1 F <br /> EL DOFLADi AUT:� <br /> A .WARGARET rD�FR GA Gene ato sSleAddress(IFdlBerent hen mailing addres- 1— G <br /> 2,270 ELDORADO ST <br /> STOCKTQr' CA 9505 <br /> Generatofs Phone: <br /> 6.Transparter1 Company Neme E a n o ! � § <br /> NIP ErivIPOri.ryteriicll vefY(G'2s U.S.EPA ID Number <br /> 7.Transporter 2 Company Name C 'd', T 0 0 0 8 2 H 24 7 <br /> A.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address <br /> DEVIENNOPeERDOON U.S.EPA ID Number <br /> 2000NORT,H ALAM_EDA STREET <br /> COMPTQit CA, 90222 <br /> Facill Phone: �7 e - <br /> so. 9b.U.S.DOT Description(including Pml Shipping Name,Hazard Class,ID Number, ` € 0 u' 4 <br /> HM and Packing Group(rfany)) 18.Containers <br /> 11.Total 12.Unit <br /> l. <br /> 1. t < No. Type Cal ly Wt.NOL 13.Waste Codes <br /> o � ry�993,VA's—,.-z PI,tTkl26i?tsGuidE,r:. .s. <br /> 3;FGilf j3aseline aD�V�EerA9ixvre} <br /> 0001 943 <br /> LU <br /> 2. 0 01 T-r 7�5� <br /> U <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Infonnaflon <br /> 1)GASO1,1tvEfv" ,TErRMi`{TIlRE. 'tEARPROPERPPE Vii iJHANDLNG. ERG*i28 <br /> f <br /> C <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: Thereby declare thatthe contenfs of MIs conalgnment are fully and accurately described above byfhe propershippingname,and are dasslfied,packaged, F <br /> marked and IebeleNplaceMed,end are In all respects In proper condHloh for transport according to applicable iMemallonal and nal governments!regulations.If export shipment and I am the Primary �I <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minlmizatlon statement Identified in 40 CFR 262.27(a)(If l am a large quantity generator)or(b)(If m uan' rpF <br /> aneretofsl ro nine ypsd Name hty generator)is he. ,. C <br /> Igoe um on ay ear { <br /> c�K crT e l6 <br /> F 1fi.Intemationel Shipments _ (,F y` <br /> _ ❑Import to U.B. - ❑Exportfmm U. . Po or /exit: C <br /> Trane Ill nature Por ex ortsbnI : f <br /> W 17.11rensporterAcknowledgmentof ReceiptofMaterials Date leaving U.S,: <br /> Trenspo 1 PdntedRype Name <br /> a � Igoe he <br /> A) on ay ear i! <br /> Transporter2Printedliype Name - I 2 7 <br /> 5 e <br /> on ay or <br /> 18.Discrepancy <br /> 182.Discrepancy Indication Space I <br /> ❑ Quantity ❑Type ❑Residue .1 <br /> ❑Partial Rejection ❑Full Rejection ( <br /> 18b.Altsmate Facility(or Generator) MenNes1 Reference Number. <br /> =s U.S.EPA ID Numher <br /> Fall sPhone: <br /> 18c signatureofAltemate Facility(or Generator) € - <br /> :� Month Day Year <br /> y19.Hazardous Waste Repor!Management Method Codes(Le.,codas forhazard0us waste treatment,disposal,and recyclingsystems) <br /> C2. <br /> 2 <br /> .! 3. 4 <br /> 20. <br /> PriMedDesignated Facility Owner or Operator:Oper:CediBceOon of receipt of hazardous materials covered by the manliest except as noted in Item 188 <br /> lTypad Name <br /> Signs I <br /> �`�y�. Manch Day Year i <br /> .PA Form 8700-22(Rev.3.05) Previous editions are obsole e. <br /> DESIGNATED FACILITY TO DE TINATION STATE(IF REQUIRED) <br />