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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A D 9 8 2 0 3 0 2 0 7 1 M 877-7267 018851337 JJ K 5.Generator's`� Name amend Mailing Address Generator's Raltallid ` Sithe Address(if different than mailing address) 1400 00u&B Shat-SbP 1000 833 E 81h Street Omaha NE 68179 SbcNbn CA 96306 Generator's Phone: 91 6 6 4 0 - 0 4 9 6 6.Transporter 1 Company Name U.S.EPA ID Number Ammim integrated Services,int- CAR 0 0 0 1 4 8 3 3 8 7.Transporter 2 Company Name U.S.EPA ID Number V�4!�A%J wLyx v�cv�-ti.-C �tw1 C 8.Dsi nat d F�cili Nam and ite Address U.S.EPA ID Number 16M.17M1 Sheat Long beach CA 90813 6 ,�.� CAD02840901 9 r Fgcility's Phone: 50 } 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit f HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1 Non4W A H2=1 dONa YItreM.SOMA MW D111161I 352 ! 00/ DM /©a P € W 2. ►?G "7.A(Z0:)le S vJ NSCE�c,i buip ! - � © 33 3. T 1 A t 4. r k r 14. tial Handlin struction nd Additional Infor ation 1 14.eal dearppropriar a PPE when handling waste. Weights or volume are approximate. j 9b.iy Profile NNwwnnbbeer: 113470 AIS Job Number:79023-74 �t422686 cib.a� ego FLC- t^ : e 1331q A15 Jv-�-aMAM007:-790al, `M -34t 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,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/Offeror's Printed/Typed Name UN E N-(}Lf= OF' N P Q R. Signature - Month Day Year C}(2 LOS 6'AWC4-+Ey- J16.International Shipments F- ❑Import to U.S. El Export from U.S. Port of entry/exit: _ K Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year IL Z Tra po er 2 Pri yped N n Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity Type Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: La 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) 0 1, 2. L 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of ftarclous materials covered by the manifest except as noted in Item 18a Printed/Type Na Signature M nt Day Y r < EPA Form 8700- (Rev.3-05) Previous editions are obsolete. DESIGNATED FA ILITY TO DESTINATION STATE(IF REOIIIR D)