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\! ! ID <br /> \ V0 C: <br /> T <br /> v �G) 0N p <br /> CD ao m � oQ <br /> o CP j � � <br /> 0 = � Q0 4�1 <br /> mI��r�a 1 V <br /> I11 t.0 0 <br /> W <br /> 1 co <br /> nl m <br /> waaae prim or type. CD <br /> NIFORM <br /> \ UWASTE HAZARDOUS 1_Generay-IO Nu ber Fmm AppmveE.OMB No.2D5D'0as. T � 3 <br /> Sv MANIFEST A [ Om0 3 <br /> fi 441,30 p�dPB°Y,IigAtleroa is'tK' � . 02606"1831 JJK m m <br /> C�„/ER Si � <br /> CD <br /> LONG BEACH <br /> mnsrm's Pnone- CA qOt309 1��E NA.MMER LN O <br /> e.TfapRa[ om�,,, STOCK-TON CA 86210 N <br /> rt�R4i'ruWIHUNMtN I: C:) <br /> >.7ranspoRer2 Company Name II4l; U.a.EPAID Numte, r 0 <br /> IEMArtRY H' t.- A K 0 0 0 1 7 9 0 1 10 ,--f <br /> ECYCLING INS: no EPAIDNumber 0 0 <br /> a. k eViff;pj ,A K C 0 0 1 9 g 2 1 7 <br /> _ OD 77 <br /> CARR.FEDNb 2MSI Ut-r. .r,;,A lit-.t;v us.F. Numear <br /> fECATE Be MA 21630 TI,1.Krv; , <br /> Fa<iliy's PM1one: 415 b62 9800 C— <br /> M 9 0 0 1 <br /> ga. eb_US.mr, roc,W4on(intlutling Proper SM1ipping Name,Ha>and Class,ID Num 1 10.containers <br /> HM and Packing Group(it any)) 11.Total 12.Unit 13.Waste Codes <br /> I. _ C No. Type miry OuaWl Nol. <br /> r o X WATER)3,PG 111(00011 .I u, r v a _ tJk'y{J7 p0'f8 3A3 CO <br /> S Cn <br /> z 2. <br /> .� (GASdLINE.RAGS).4.1.II f F.?001( '-' v L..,u...,. U i 18 352 Q- <br /> 0 <br /> CD <br /> 1 <br /> 4. <br /> I \ <br /> 1 IV <br /> ' 14.Special HandLng in lurch and Additional Information <br /> L8 2)k 19.14:37 Flat xrwbieSOWS VrirrisTy Exporter Tsilnarry RecycHn,. <br /> a <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: hereby declare That the contents of this consignment are fully and accurately described above by the proper shipping name,aid are classified,packaged, � <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intematlonaland national talre regulations.if export shl ment and l am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 9ovemmen g p p <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 generator)is We. <br /> Generators/ORerors Prmted7Typed Name Signature Month Day Year <br /> _ i I I,I I O0L <br /> 16,Intemational Shipments 0 <br /> r— ❑Import to U.S. ❑Export from U.S. Port of entrylexib CD <br /> ? Transporter signature(for exports only): Data leaving U.S.: <br /> ce 17.TransporterAcknow4edgmentof Receiplof Materials <br /> I-Transporter 1 Printed/Typed Name Signature Month Day Year <br /> P <br /> z Transporter 2 Prinfed/ryped Name Signature Month Day Year <br /> Of Q <br /> 1 CD <br /> 18.Discrepancy S <br /> IIII1 18a.Discrepancy Indication Space ElQuantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejectlon Q <br /> I CD <br /> Manifest Reference Number, <br /> >- 18b.Alternate Facility(or Generator) U.S.EPA ID Number Q <br /> _J <br /> U CD <br /> LL Facility's Phone: <br /> Q18c.Signature otAlternale Facility(or Generator) Month Day Ye <br /> Z n <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 2. 3. 4 <br /> cQ <br /> Q <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a pj <br /> Prinled/TypedName Signature Month Day Ye <br /> Q <br /> EPA Form 8700.22(Rev.12.17) Previous editions are obsolete. GENERATOR'S HTIA <br /> cn CD <br /> � O <br /> v Q <br /> _ CSD � <br /> CD <br /> v �o <br /> Q en <br /> 00 <br />