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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 rAI G0 38887 1 90045183 011385392 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) ljits Leaut� #114 U S EE3Ut VK351209 5410 Pacific Ave. 3410 Pacific Ave. Generator's Phone: 3tjcktan. CAq7111=171-17 z35,',07 6.Transporter 1 Company Name U.S.EPA ID Number ter Ji c V L J e S uecli�itk. I,I-s_;te ac 1 v t I aTt_ lI f1ti-,o 0 7.Transporter 2 Company Name „r � � U.S.EPA ID Number 8.Designated Facility Name and Site Address �sq St 0e nt ur v EMN. LLC U.S.EPA IDD Number 2k95 Nc-N1aYiu L`> E:�-=t Fer'nlev. N14 89408 Facility's Phone: 775575r--760 id L G 1 -5w ga 91b.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. 'UN1950, Waste Aerosols. [flammable. (each not 1 i F 00016 A _ 331 r5001 o e< ceediric I I.. cacacit�=J 1 2. 1, ElFr)#i2E ga Z z1E�43266, Waste Corrosive Ziouid. basic. 00008 c, 1212 D002 LU 3riora-=nr7.c. n. c. E. t6odiugi Hvat-o ole= Potassium Hydroxide). 8, PG I1. ERG#154 3. 4. 14.Special Handling Instructions and Additional Information i. 1027!34 Aerosols. Flammable) 2. 1Q2791(Corrosive Basic Liauids) 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above byJhe 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 govern I r ulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Co nt. I certify that the waste minimization statement identified in 40,CFR 262.27(a)(if I am a large quantity generator)or(b) am a mall quanti g r ator)is true. Gen or's/0 eror's Printed/Typed yped Name Signature!��t a (E x C e lot DC on ay ear �nI i2l 1 213 12018 16.Intemational Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z ' Transporter signature for exports only): Date leavl U.S/ LU 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedrryped Name Mont ay Year no Anthonv Mack I 12 28 1201e QTransporter 2 PrintedlTyped Name �, � Signature Month Day_ Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity 1:1 Type El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU L ) 2. 1 r�7 3. 4. tf 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typ e Sig M th EPA Form 8700-22(Rev. -05) Previous editions are obsolete. ESIGNATED FACILITY TO DESTINATION STAT;--,(IF REOUI ED) w ,,:.1c��,__t:.t�t_212112119I 29 �4�►71�1"��tZ. 041 e'335 E M