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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 0 Number 2, Page 1 of 3 E g ncy Response Phone 4. Manifest Tracking Number 9 WASTE MANIFEST C A D 98200302 0 7 ) d ,.) 99 JJK 5, Bator am not a� IUpp Add[eas 1511105iiiiiiiiiiiiWNUMMOINnIBMGenerators Sits dress (Bdinerenilhanmailingaddress) I�M0�0 �.[ , ;�3D PECwC li�Md 1400Da1� 8MM - Oil10H0 833E ftObad Mill IE 06,76 SbCOM CA 861116 Generators Phone: 640 % 0496 6 Transporter 1 Company Name U.S. EPA ID Number lSwvidarkill CAR000 / 48338 U.S. EPA ID Number 7. Transporter Company Name res i nate Fa ' a es Site Adds - U.S. EPA ID Number B. D UM OMI S VIN Pill Kirriiiiirtl d"A ; CAT 0 0 0 6 4 6 1 1 7 Facility's Phone: (� dW 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers it. Total 12. Unit 13. Waste Codes HM and Packing. Group (if ani No. Type. Quantity WI.NoI. � 1Wo�rlicRAMm►��3;w � ltWdMMldClw�l 161 01 CM Y 2 2. W 0 3. 4. a a ar��lnk "VWdW" Kindling . Weighta or volumes are approximat® . ATS Job/79023- 44 ProfilerCA615237 15. GENERATOR'SIOFFEROR'S CERTIFICATION:- I hereby declare that the contents of this consignment are Polly and accurately described above by The proper shipping name, and are classified, packaged, marked and labeledlplacamed, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. It exact shipment and I am the Primary Exporter, I sanity that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. A ' I certify that the waste minimization statement identified ill CFR 262.27(a) (if I am a large quantity generator . r (b) ('dl am a small qu ntity generator) is We. Gener�atafsl�mrs y�ad Name Signalu Month Day Year 16. International Shipments Import to U.S. ❑ Export fr mU.S. Pad of entry/exit - Z Date leaving U.S.: Transporter signature (for exports only): IT Transporter Acknowledgment of Receipt of Materials W TransporterMonth Day YeqTransporter i PdnledRyped Name r Signature r I / N J l� Q y r Z. Month Day Year Z Transporter2 Printedlfyped Name Signature a r I 18. Discrepancy 18a. Discrepancy Indication Space 11 Quantity ElType ❑ Residue ❑ PaNal Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J V Facilitys Phone: w 18c. Signature ofAltemate Facility (or Generator) Month Day Year Q Z y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 0 1. 2. 3. 4, 20. Designated Facility Owner or Operator: Clarification of receipt of hazardous materials covered by the manifest except as noted in Item 181 PrinledlTyped Name signature Month Day` Year EPA FormB700-22 (Rev. 3A5) Previousedii sare obsolete. DESIGNATED FACILITY TO GENERATOR