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0r1erl�, Vl�e ll 33 <br /> F& <br /> Please print r. »'a % OMB No.2050-00,39 <br /> UNIFORM HAZARDOUS I.Generator ID Number 2.page I of Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST A L 0 0 0 2 t3-3 T �3 4 isoo),ll-r:1 8 <br /> _r.Emergency . 1 014788465 FLE- <br /> 5. d Mjfingi Generator's Site Address(ii'different than mailing address) <br /> VZ('�0611'11 Air,1 U;Wre0S9L0QES <br /> 200 N 14�iAner-Al <br /> SAME <br /> Generator's Phone: �ZF�IYad-42,flj <br /> 6.Transporter I Company Name U.S.EPA ID Number <br /> C I pail N arbot-5 E ny ironmelli Services,I ilr- <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> -lean 4�)&-jrs'Viilmin,4��Ian UC r- ok M n• A A A jr4 r4 C- rz <br /> 1.737 Fast Denni stli, <br /> Wiiirnliftn,CA 9t)744 <br /> Facility's Phone: �1�214 9-'�qssli <br /> ga. 9b U.S.DOT Description(including Proper Shipping Name,Hazard Class,1D Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI'll <br /> tr 1 1 AZ1. <br /> HARDOUS WASTE,Ul(OIL AND Wil�li <br /> 007 PM 04ibO P <br /> rj <br /> ji <br /> 2. <br /> ILI <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Z-2-1 51-65 lass <br /> Cot,�341!rrMalril�,q cprtmft��r,!�We*�aerr,.,, <br /> �L In add --Zil zczlxln:42��Mu;oaarz Ql� ogg ii: <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described e by the proper shipping name,and are classified,packaged, " <br /> marked and labeledlpiacarded,and are in all respects in proper condition for transport according to applicable internationaland nafiO4 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 EPAAcknowledgmert of Consent. <br /> I certify that the waste minimization statement identified in 40 GFR 262.271(if I am a large quantity generator)or amp small quantity generator)is true. <br /> Generatol <br /> IT&s Prntedi Name Signature Month Day Year <br /> Lo- I I Ill I <br /> ..j 16.International Shipments <br /> F- E-1 import to U.S. ❑Export from U.S. Pod of entrylexit: <br /> ;-S Transporter signature(for exports only): Data leaving U.S.: <br /> to 17.Transporter Acknowledgment of Receipt of Materials <br /> to <br /> F- Transporter 1 Printedflyped Name Signature Month Day Year <br /> le- I <br /> 0 <br /> LL Ta!�C.dar-?Fntddyp�d Name Month Day Year <br /> Z Signature <br /> ,t 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Ll Full Rejection <br /> Manifest Reference Number. <br /> 11 Alternate Fal(or Generator) U.S.EPA 10 Number <br /> 1 L6 Facility's Pi <br /> 1 1 So.Signature of Faci[ity(or Generator) nth <br /> ISI L'j Day Yes r <br /> 47 19.Hazardous Waste Raport Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LJ 1 12, <br /> 14141 T C <br /> 20.Designated Facility Owner or Operator:Certficatinn of receipt of hazardous mall covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> -j C1 Y-Okli Ll I I <br /> EPS <br /> A Form 8700-22(Rev.12-17) Previous editions are obsolie. IGNAIM FACILITY TO EPA's e- MMANIF T SYSTE. <br /> H!"Llo- in-1 liiq3r;t fQT sn"I -iili accep! tn stl �31 20P12S4'U0-Qq1 PPW <br />