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Loa= : FRESNO rRna* ,F1ctvCr, j, <br /> Please print or type. Form Approved. OMB No. 2050.0039 <br /> UNIFORM HAZARDOUS 1 . GAene�re�torVl+ n n 4 � . .� � � $l 2.1 age 1 oft 3CE�merg�en�cy�es o�nse�P�ne7 L „ 4. ManffestTracking Number. <br /> WASTE MANIFEST 0068022 <br /> 90 GBF <br /> 5. Generators Name Namee and MallinaAdd�gss Generator's Site Address (if different than mailing address) <br /> � <br /> ' "F f w `� CORP <br /> satin =:1NIXY A81A3 <br /> LATRRPJPV CA <br /> -Generator's Phone: - - 12a 9 4 2 = 5 ,:, 6.12. <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> Cr , FAff . i : IX71 IT T , R n n 11 t :l n n 6 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Si Address U.S. EPA ID Number <br /> BRITAGR EVu'TR.�+f'�k'E8NrfeA.% SERVIlFXS*f :O %: k�.-- A 2 n n R 1 7 n 5 4 119 <br /> .. _. .. . <br /> ! 84 E STOREY RD <br /> . r%n1 . T" r.=Z '€k2 i7r, T i. rs i : i - L • i <br /> Factiily's Phone: <br /> 9ao . <br /> 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (d any)) No. Type Quantity WLN01. <br /> '^ L3G''j' �1l.L�i. �� Ct:,r`L?i7�' r•i ,• >: CS.L3' Cit~ E� f�C:;� , tvFtP..�.:�!^ 'j ; .,5i�: <br /> Ota4, a ) <br /> 0n DVA % aw. <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> 14. Special Handling Instructions and Additional Information <br /> 11 CIC : 42au%:, 4o•- iq T30 . P .1 ,1167 1 MKI4 1 <br /> t; t?mraot [MM-1 tyr vwfferawr comers atl`rlicy at?tticet7ty 7i'i Imial Jratrt5rh? jPa Err Wd Ot• subs4t~`t(tr" 2rI4j'riLd'tBt 7iif1t6�tGi�zF6 QI'e gerwaloYs va tett'. <br /> 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, ani are classified, packaged; <br /> marked and labelediplacarded, 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 <br /> Exporter, I certify that the oohtents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent 0 <br /> I.certify that the waste minimization statement identified in 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (fl am a small quantity generator) is true. <br /> Gerleratoes/Offeroes Printed/Typed Name Signature Month Day Year <br /> 01JIS Q0 riuo ab. 30 3 <br /> 16. international Shipments <br /> ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: <br /> ? Transporter signature (tor exports only): Date leaving U.S.: <br /> W 17, TransporterAcknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Pdnted/Typgd Name Signature Month Day Year <br /> a t <br /> zTransporter2Pdntedliype Name Signature Mo th Day Year <br /> t- 6 <br /> 18, Discrepancy <br /> 18a. Discrepancy Indication Space D Quantity ❑ Type <br /> ❑ Residue F] Perils[ Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Altemate Facility (or Generator) U.S. EPA ID Number <br /> J_ <br /> V <br /> LEM Facility's Phone: <br /> 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> Q <br /> z <br /> N19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) <br /> G 1. T <br /> 3. 4. <br /> ly <br /> 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item Ise <br /> Print Name Signa Month Day Year <br /> EPA Form 8700-22 (Rev. 12M17) Previous editions are obsolete. IIESIGIATED FACILITY TO EPA's a*MANIFEST SYSTEM <br />