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Please print or type. Form Approved OMB No.2050-00. <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest TrackinU NumgCer <br /> WASTE MANIFEST CAL 000 443 266 a 14-X.A 4 of 987 F L E <br /> 5.Generator's Name.and Mailing Address Generator's Site Address(if different than mailing address) <br /> Aisle 111356 <br /> 1450 N Benson Aire STE A 4219 Morada Lane <br /> Gen :CA 91788 1009 St"Mon, CA 95212 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Big Sky Enviromental Solutions CAL 000 346 014 <br /> 7,Tr sporter 2 Company Name U.S. PAID Number <br /> 6; <br /> 8,Designated Farilityjame and Site Address U.S.EPA ID Number <br /> Crosby&Overton CAD 028 409 019 <br /> L11 p630 V*81 110` St <br /> Fa�firy%#*mA, CA 90913 800-827-6729 <br /> ga, 9b.US,DOT Description(including Proper Shipping Name,Hazard Class,l Number, 14-Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.lVof. <br /> 0 1 R$, UN-1N,1,Waste FlaMMabie Liquid, N.O.S., 3,PG Ili 0 U 001 ED018 1213 <br /> X (ft9014)(RQ w D001) i1A <br /> z 2. 7� <br /> LU <br /> 3. ;-11SPOSAL,YRf�4TME.NT OR RL-71SEC'EFVED,FLANDi.FA AtJO E <br /> 1tM1TS( A 7�7}IEKl% CROs TSV OF flRII3 FOR . <br /> �'rTf{ MF.N!'AL SY TI-r>;pgp do OVF3l7'ON,IN OpERwTES ' O ,trY' <br /> T}IE ENVIRON <br /> TIE RFS0 CE CONSERV� OT�CI']ON AGgJCY pJ TOXiC U8S7ANC$ C JNr3w <br /> 3 <br /> 4, IFAMM A STATE REGi11A BONS, CROSBY Y ACT OP 19 6 TOGg�� pftoviS NSwil <br /> or <br /> .,r,hRnrNr{',C'tF.PT 71iE RF_Fl"y NCM WASM Ary'AUTON PIAS - OP CA81�[- m®�._.�,.....-- <br /> AI,1., WAS7'g IIA SEEN"A SA-y <br /> 14.Special Handling Instructions and Additional Information <br /> t..:_ -Ar PPI=, <br /> roCde 91111 fill 15757 <br /> EMWOO CYContact: JeffRhodesb10- 1-2128 <br /> 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, <br /> marked and labeledlplacarded,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 Pdmary <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 minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. <br /> Generator's/Offeror's PrirtedfTyped Name Signature - Month Day Year <br /> L<4yw,� a7ggd <br /> J 16.International Shipments i <br /> t_ ❑Import to U.S. ❑Export from U.S. Port of entry/exit <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TrarsporterAcknowledgmentofReceipt ofMaterials <br /> LLI <br /> 1—" nature Transporter 1 Printed/Typed Name Signature <br /> 9 / - Month Day Year <br /> IL <br /> aTransporter/PtedlTyped Name Signature / Month Day Year <br /> LIZ <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity El Typo ❑Residue ❑Portia!Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z: <br /> V5 19.Hazardous Vyaste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLI 1l 2. <br /> o R//�( 3 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt od"bazarclousjnaterials covered by the manifest except as noted in Item 18a <br /> Printed/Typeddme Signature Month D,ay Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATN <br />