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Form Approved. OMB No. 2050-0039 <br />riecib.e <br />t <br />pun til typc. <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />CAR000225557 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />800-556-9090 <br />4. Manifest Tracking Number <br />0 20 6 2 30 8 9 JJK <br />5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />YRC Inc. dba YRC Freight <br />10990 Roe Ave. Overland Park, KS 66211 1535 E Pescadero Ave <br />Generator's Phone: 913-344-5205 - I Tracy, CA 95304 <br />Transporter 1 Company Name U.S. EPA ID Number <br />Ancon Marine I CAD980737068 <br />Transporter 2 Company Name U.S. EPA ID Number <br />t-- 6 . Ivrk_ts 'Nd-tok,_ UK- I 0,4-4-p_a)i)iR'))(st <br />Designated Facility Name and Site Address U.S. EPA ID Number <br />Crosby & Overton <br />1630 W. 17th St. - Long Beach, CA 90813 <br />Facilit 's Phone: (562) 432-5445 1 CAD028409019 <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 (if any)) No. Type Quantity Wt.Nol. <br />rE Non-RCRA Hazardous Waste Solid (Debris, Neutralized 181 <br />0 1- <br />,.... g Hydrobromic Acid) 2 DF 250 P <br />z <br />Lit <br /> <br />0 <br /> <br /> <br />14. Special Handling Instructions and Additional Information <br />1. ERG 171 Debris 2Y55g Profile# 116389 <br />. <br />ERG Book In Valticlin Wear proper t q ( 1/441(Ae i. <br />OSHA 'waved PPE When handling the <br />materials on this manifest. Job* 400.13.28539 <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard are classified, packaged, <br />marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemationaland national governmental regLilations. 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 />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity gen ator) or (b) (ill urn a small quantity generator) is true. <br />v <br />G ner tor's/Offeror's Pri <br />\ <br />yped ame - Sign tur M pay_. Year <br />k V -(4/ <br />_j 16. International Shipments <br />E Export from U.S. Port of entry/exit: <br />F_ <br />I- lmppro U.S. <br />Transporter signature (for exports only): Date leaving U.S.: <br />CC 17. Transporter Acknowledgment of Receipt of Materials <br />1-- W <br />at <br />Trans er 1 Printedrtyped Na e Si ure Month Day Year <br />I C3) i 0 a. /1Z_(1.co - <br />Da z <br />g <br />6 rea { / <br />Tra e 2 Printed ped <br />--, <br />el•tilje,i- I n'- <br />M00,1, Year <br />18. Discrepancy <br />Discrepancy Indication Space LII Quantity Ehil Type El Residue Partial Rejection Full Rejection <br />Manifest Reference Number: <br /> <br />CL" I 0 4/ Nt <br />1÷ <br />----- <br /> D <br />ESI <br />GNA <br />TED <br />FAC <br />ILITY <br /> <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) Month Day Year <br />I I <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 />20. Designated Facility Owner or 0 orator: Certification of receipt of ha- rdous mate . Is corred by the manifest except as nded in Item 18a <br />Printed/Typed Nre .,„, VI i 4 , , Signature Mort (11, 1 Yiarc <br />k.....S21/ / / (il 7 I (A- ISA I <br />EPA Form 8700-22 (Rev. 1 -'t1) Previous editions are obsolete. s e-