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SK SH I PM 2 -10 1 li'i r 4 <br /> Please print or type Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number Y r -t ` 2 Pagel of 3 Einer <br /> c1La4�1 cy Response Phone 4.Manifest Tracking Number <br /> CAGbrJ._:,"]71 ,.. /L,�c1 <br /> WASTE MANIFEST 1008029160 SK-S- <br /> 5.Generalor's Name and Mailing Address Generator'S Site Address(if different than mailing address) <br /> Ini ed.1011 Inc 111 yr•E,U l ort I IIL <br /> P.M. rn;i 61L:3 i4Ittni RDPer Hol-fdahI WEE .[ t; a Dr <br /> t ijl..i,,, CFS <br /> Generator's Phone' y— ©�'��93t�1 Ty"I_:,�"Trig) CA 15rJ —.,928 <br /> 6 Txa spgrt4- Company Name U.S.EPA ID Number <br /> ��lr f Y-tai c t.fV <br /> by 5-1 Emb INC7XNt y tdE�ltjic0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLraIV 1-10., 16 ENV SVC INC. <br /> B,Designated Facility Name and Site Address ILEFfN 3nai'4 �Lr;iE U,S.EPA ID Number <br /> 15'1 <br /> SAN JUziE , CA 95132; <br /> 44'ld-4�1—�}9F.r 46a:1i��9t9/�a X O <br /> Facility's Phone: <br /> ga• 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(9 any)) No. Type Quantity ,_ Wt.lVo1. <br /> 1'fit� C1N—t2C'RA lith= ;4--iIE' +'. <br /> (' <br /> o La�LJ�1aEi, {1)EGRFA"8E':. 1 J <br /> 7r 1 " ( <br /> cc y;r <br /> z 12 <br /> LU <br /> U <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information "t'SI)t SJ 8701216 12 C 0 i`Lir;8 <br /> 24NFe`Cb' ecl—�.F3-17 CFi �'!1F5-Cont��r; =i��d b; r.r aratDl^ �c;:f ncy cl.l h7r°,: <br /> r- rc :i-r•i Pr t il It- `rr.,._ ,,;• a c rrnr t ! p�tz.a i <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified, ackaged, <br /> mad and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational 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 /> T 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'slCi eror's Printed(fyped Name Signature Month Day Year <br /> a, t` r c <br /> 16.Intemabonal Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexiC <br /> Transporter signature(for exports only): Date leaving U.S <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> U.11 <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> CL c <br /> z Transporter 2/Ponted/TypedName Signature Month Day Year <br /> 9 r, <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space Quantityj ❑ <br /> ❑Type ❑Residue Partial Rection Full Rejection <br /> I <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facihtyrs Phone: <br /> w 18c.Signature ofAllemate Facility(or Generator) Month Day Year <br /> d <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> n A. 2, 3. 4. <br /> 1•�]%r1 <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(fyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />