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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 I Generator ID Number21 Igei of 3 Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST . A 0 9 0 ..n 0 3 2 ��0 a rf a ST. 'i. - . "�' ') JJ 3 ' 5. Generators Name andNeill gAddress �".a MA Generators Site Address (if different than mailing address) m O - 4 we `v. kwo E as shvm 8kcidon CA SW Generators Phone: 91 6 6. Transporter 1 Company Name U.S. EPA ID Number Armfimn hdMabd Sew % hoc. C; A R 0 0 0 1 6 8 3 r A 7 Transporter 2 Company Name ft U.S. EPA ID Number D 8. Designated Facif Name and Site Address U.S. EPA ID Number YAM . ": m Cocmwml CA KM Facility's Phone: 310 53741W C A `k 0 8 0 0 1 3 3 Y 2 ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit HM and Packing Group (if any)) 13. Waste Codes No. Type Quantity X/Val. 1 wkxgWPA "awmAls, sLwgj pJamild Oro om iPu,�w.\� w.MN+\'Hrcea, \ MMwnlwlfNpRnnNLw.,MMaFY!.ro4# d.1m^^� Z 2. w THIS WAS FE STREAM HAS BEEN QUALIFIED 41 FOR RECYCLING/TREATMENT AT THE DeMENNO/KERDOON DBA W 3. RECYCLING FACILITY IN COMPTON, CALIFORNIA . THIS FACILITY HAS THE NECESSARY PERMITS T —..mm -._----- RECEIVE OUR WASTE STREAM AS QUALIFIED.EPA ) ' i 4 _ . .. .. ..._. . __ . _._. . , 1 isomm wrap 14 Special Handling Instructions and Additional formation eAr proF7 7' �: tis�a� To lttlmv .: liri. , wa�.`:"�'h$;.H or v€� umv.9 a� , AIS =.fps n' 7023 - 64 15. TOR'SIOFFEROR'S CFRTI ICATIO : 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 tens of the attached EPAAcknowiedgment of Consent. .. I codify 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 gene `to )`is two Generators/Offerors Printed/Typed Name Sig atufe f 1 j Month Day Year 16. International Shipments / - Z ❑ import a „ , '. Ira rtto U.S. Ex ort fraph U.S Part of entry/exit: Transporter signature (for exports only): ° Date leaving U.S.: w 17. TmnspoderAcknowledgment of Receipt of Materials Transporter 1 PrintetlRyped Name Signature «k 4 Month Day Year a �l -A 9�, l ( ` did s� t ,` e 0 a Ms Transporter 2 Printed/Typed Name Sig%IGre r 1 Month Day Year" 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity � [:] Type LJ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA IONumber J U LL Facilitys Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z N19. Hazardous Waste Report Management Method Codes (i.e., codesfor hazardous waste treatment, disposal, and recycling systems) ® 1 . 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest exceptas noted In ilpm iQa PnntedrFyped Name 8 Sgnature I . 1 Month Day Year 01 \ r: i , , % t (( ) ,A 11 � Iq EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete.. � DESIGNATED FACILITY TO GENERATOR