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4t< CJ1513Q PPA 'YP2,:to Please print or tvae.'(Form desioned for use on elite (12-Ditch.-newriter.l P— n --A ORAD ni )nrn_mmn EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY (,>arf Hjrttrf! has the a#Y, l:vilpli2✓'tfi r')tt'it*s fte xnd 1mtii x vii Yet the waste the f�N3rereltof !`5 A'liPp3f-w. UNIFORM HAZARDOUS 1, Grnergtor D N b2. >y $ a Pae 1 of 3. E Pone 4. Manifest Tracking Number WASTE MANIFEST 000971174 F L E 5�enerato�s Narpa and Mailing Address Generator's Site Address (if different than mailing address) f5tfl9 ?.7d Ity t7*5R@ +,:.ris?iftiAf Sao . Jt a%M Cout'*4 1--16W Vast ` C vhp , PO r7a7?. '11810 i `f'33 Ea# i i k net r' M..W..J RtxkVi'a, CA i S1.5Liii L", CA 95240 Generators Phone: 4Fr0•31_tt`i j}.41rt�}rlk�JlrRK'l' 6. Transporter 1 Company Name U.S. EPA ID Number {; -E- n't i teat, ni Errsefvict?,; drin M A, El 0 3 9 3; 2 fi 0 7. Transporter 2 Company Name U.S. EPA ID Number 8.,,QQ,,esignated Facility Name and Site Address {.,k;a n (^}afth -4 1-2 tlat� �.� U.S. EPA ID Number tm F"�C�t1r d f� cad 1 = C." Q 9 r' 9 (} I 4 r,) Ls P ofttg. `fit. 757 i Facility's Phone: tl9 t } 4764JA405 ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. � 1•�'�'f�>�,i+lF . ? i • a lilt �+ix�i �� � ( a .. >' !` W y Z 2. W 3. 4. 14. Special Handling Instructions and Additional Information 414499- '�'' 1 � -;. � x � � �•"7 !! � "7 " "� � ` `•'"? .� is �.! ! .�.. ! C - J moi,. t� j 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, marked and labeled/placarded, 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 Primary ' Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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. enerator's eros PrintedfTyped Name Signature Month Day Year -J 16. International Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: Z Transporter signature for exports only): Date leaving U.S.: W 17, Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed[Typed Name Signature Month Day Year �°•� fA it ZZ Transporter 2 PrintedfTyped Name Tignature Month Day Year Jr H 18. Discrepancy 18a, Discrepancy Indication Space El Quantity El Type El Residue Partial Rejection ❑Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J V Q LL Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY (,>arf Hjrttrf! has the a#Y, l:vilpli2✓'tfi r')tt'it*s fte xnd 1mtii x vii Yet the waste the f�N3rereltof !`5 A'liPp3f-w.