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Please print or type. 4 GENERATOR 0 1 UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number . '., ' ;':,.. . ,t _ 2. Page 1 of 3. Emergency Response Phone f.,'.• 77. .‘ .' ' 4. Manifest Tracking Number JJK Generators Name and Mailing Address Generator's Site Address (if dderent than mailing address) Generators Phone: , I Transporter 1 Company Name 1.1.S EPA ID Number I Transporter 2 Company Name U.S. EPA ID Number • I Designated Facility Name and Site Address U.S. EPA ID Number *A Kistilisson Liman (Avit'1,A iia 1 1$231 Oil ftilni M. Kdellorion CIN , CA 93239 Facility's Phone: I ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11, Total 12. Unit Him and Packing Group (if any)) No. Typo Quantity WtIVol. 13. Waste Codes i el 2. .1 _ 14. Special Handling instructions and Additional Information ' 01431110014 0 .L".'...4c .. . .7 4 7321344 jab. 22-189211 7-Y- e./s- '1,6 1.5 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents Of this consignment are fully and accurately described above by the proper shipping name, ard are classified, packaged, marked and labeledlplacarded, and are in at respects in proper condition for transport according to applicable intemationaland 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 EPAAcknowledgment 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/Offeres Printed)Typed Name Signature i'. Month Day Year g ((4.6) (1 CY L. ( ( I Xt.4-Yr:, 'M co',:ie, II Ii, I _I i— _?. International Shipments Import to U.S. LI Export from U.S. Pod of entry/exit: Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day year 1 i I, Transporter 2 Printed/Typed Name - Signatule 'Month Day Year I III ) FACILITY ---+ Discrepancy Discrepancy Indication Space Quantity Type ,Residue Partial Rejection LI Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I 4--- DESIGNATE( Signature of Alternate Facility (or Generator) Month Day Year I I 19 Hazorrous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1 2. 3. 4. 20. Designated Facil•ty Owner or Operator: Certification iii receipt of hazardous materials covered by the manifest except as ncted in Item 18a - Printed/Typed Name Signature Month Day I I I I EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. ' 'IDESIGNATED FACILITY TO GENERATOR