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Please print or type. Form Approved.OMB No.2050-0039 T JNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number �- 021324598 JJK WASTE MANIFEST tom: . [} ri z_, + = it I ( `' �a-r 'i 5.Generator's Name and Mailing Address t;Att I l2nife t Rece1vir!r3 Generator's Site Address(if different than mailing address) Union Pacific.rRailmad CIS,GHD Jnicn Pacific Rilmad i:.(rj;i G Corp -rate Dr. 8,33 E 18-h Sti-eet indianapoliS IN 415278 StOCI`;tOn CA 95-206; Generator's Phone: ' a F r 6.Transporter 1 Company Name U.S.EPA ID Number ,rner-icen Inter;rated services, Inc. 3 S 7.T sporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number C:rosby L Overton,inc:. 1630 W. 17141 Street Long Beach CA 90913 Facility's Phone: 9-'- 19 •F r;- At 4 n A n r, 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1 Non-R RA Hazardous kAbste,Liquid(Used Gail) ?2! 01 alul � 5 z 2. W 3. 4. 14.Special Handling Instructions and Additional Information Al-vray� Wear Appropriate PPE -;-yhen hmndling t4aete_ WeightZ._: or -Tolume are almproxirn.ate_ 9k_1) Prefile Plumber: 112299 AIS Job- Number:79022-15.3 14P#22616 ?.32 .0 1 x 15 5- 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate y 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 true. Generator's/Offerors Printed/Typed Name Signatu Month Day Year �t�UlNQL\ ev1Z _ 6 z 13123 j 16.International Shipments ❑Import to U.S. ❑Export from .S. P rt of entry/exit: t- Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials u1 Signatur Month Day Year F- Transporter 1 Printed/Typed Name a C 213 z Tr porter 2 Printed/Typed Name Sig ture Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ U U_ Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardoq Waste Re ort Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) w 1 2. 3. 4. 0 - 20.Designated acility or Operator:Certification f receipt of haza dous materials covered by the manifest except as noted in Item 18a PrintedlTyped am i � Signature _ Month Day Ye EPA Form 8700-22(Rev. 2-1 ) Previous editions are obsol te. DESIGNATED- ITY TO EPA's e•MANIFEST SYSTEM