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Please p ni or fy t j form Approved.OMB No.2V%"9 <br /> UNIFORM HAZARDOUS 1.Generator tD Ncnmber [2—,1aga 1 of 3.Emergency Response Phow ,'` ' IL VAn""ll ng NumberQ Cc <br /> WASTE MANIFEST CAA 0 0 0 2 6 6 2 4 7 2 $10.=7 0 0 1 7'I9 1 7 9 7 V`V <br /> 6.Generators Name and Ma6lnp Addreas X[71,7 V Generators Slfs Address .nt#W. and g address) <br /> FW 13K tMI7 RAW <br /> M55 HOOD WAT <br /> ISACY.CA"tTT-7217 <br /> Generators Phone: 209 MMIG <br /> 6.Transporter 1 Company Noma U.S.EPA ID Number <br /> 7.Transporter 2 Company Nome U.S.EPAID Number <br /> h9 MqVMCNMWAL MVICO c A T 0 0 0 6 2 4 2 4 7 <br /> 8,Doslgnated Facility Names and Sb Address00"Ell'C .Ili.GOLUr"116 U.S.EPA ID Number <br /> LLr- <br /> W.MRT kERMI: <br /> 17 AZEUCA01714 CAD4aa 302901 <br /> Fadl' a Phone: <br /> go. 9b•U.S.DOT Desnaiption(kicW6 g Proper Shipping Nome,Hazard Class,ID Number, 10.Contokners 11.Tote) 12.Unit 13.Waste Codas <br /> HM and Packh Group(If any)) . No. Type Quantity YJINol. <br /> 1. =14.WAS"I'S HYDROM PHWM=AQLMM D= M <br /> I D F 46 P DOM <br /> 2. JW jV WAM nuc PJlUME TM FFW= 1100D DIM <br /> Malo 5.&% n r o llippl 331 <br /> ACw%i,u 1 13 F so. F 791 <br /> 4' <br /> nSIOROANM 2.0.2� �.(#cvw 2 D F 270 F <br /> 14.Spend Handling Instiuctlons and Ad Inlormatbn 7R lwviN w b7 vEM + Qplr [pk quip d�glWt� <br /> Y11 i1LjtT to {� 1ttlN� iml f17> fj <br /> MG V-7LO <br /> 1 :k ��145�A•� 9 �' S4�AAa>sl?�>��547f5tl�A <br /> 15. OENERATOR'SIGFFF.ROWS CERTIFICATION:1 hombydedam thatd*contents of this cen*nment are fully and a ccuratotydesorlbod above by ll�proper shl;Ov name,and are dans W.peckased, <br /> marked and labaledfplacarded,and are In ail rsspeds In proper condltiat for transport amWIng to applicable Inlemational and national governmental*ulalfons.If expod shipment and I am the Primary <br /> Exporter.t certify that the contents of this conslpnment conform to the(arms of the a6ached EPAAckrnowledgment of Consent. <br /> I cerfity that the wase minimization statament Identified In 40 CFR 26227(x)(If I am a large quanilly generator)of(b)(If l am a small quantlty generator U true. <br /> Gone€pinre/Offerue a PrtnfadMyped Name Sip Month Daft Year <br /> 1 010 'S 12 1 <br /> 16.Intematonal Shlpmenta Cl import to U.S. ❑Exparlfrom U.S. Port of anbylerdt: <br /> T€eneporler a{gnalure(for exports ooty): Data leaving U.S.: <br /> 0517.Tfonspoder Admoaiedgmant of RoWpl of MaWd& <br /> ju <br /> 12 Trane rter 1 P tadrfype Name Signature Month bay Year <br /> !P�`� 10 2 <br /> Treasporter 2 Pdniedlfyped Name Signature Month Day Year <br /> v <br /> 18.1)6crepaacy �-� <br /> f8a•Dlscsepancy Indicatbn Space ❑ Quantity OTypa tJ Residue ❑Parilal Re*o. ❑Full ReWJI <br /> Marnlfest Reference Number. <br /> 18b.Altemato Facility(or Generator) U.S.E lD Number <br /> I <br /> U <br /> Fadlitys Phone: y <br /> MO.Signature of Ntamate Fad Ity or Generator' Man ba Year <br /> 19,Hazardous Waste Report Management Method Codes(I.e.,oWesjAr hazardous waste treatment,dlapesai,and WAkV systema) <br /> © 1. 2. 3. 4. <br /> 20,Dea{gnated Fodflty Omer or Operator:Coftatlon of recetptof hazardous materials covered by the manlfssl except a r6d h llem 18a, <br /> n yp� nature Day ear <br /> EPA Form 8700-22(Rev.12-M Previous editions are abso le. DESIGNATED FA IL G EPA's&MANIFEST SYSTEM <br />