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Form Aoproved. OMB No, 2050-0039 GENERATOR - UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number C Ar p-,0-- 1 CA -1 I CA 2. Page 1 of 1 3. Emergency Response Phone e'00 - 5-6tio - c\ock 0 4. Manifest Tracking Number 02 2 2 2 8 5 2 8 JJK 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) Uhek (::C7 c' f-,_‘ e: 2 -1-6z-4.4e...v-b.-- (97,e, I w • -&-,,--( 10e- 42- Cit-- ctn.° Joe. v-Vro6e1-4- 7--Nz. CA\ 'IS-24 2- GeUgk5ET.ct--' . -1-K ii I -II 3- -1b 2-\2-t S I 6 Transporter 1 Company Name U.S. EPA ID Number I e-tn,-,c. 41 i50 7'171 OP cS TiAnsporter 2 Company Nape U.S. EPA ID Number CiVOS 47, C)V 4-,1/40 VA i L44 C- I Designated Facility.bme and Site Address U.S. EPA ID Number "I eit 011c,-Y2--: c.,.*-4. C.arzne... „T 1(0 lA) 1-7 -t-'4 c•-e-,er.,r- C--PAI--)07-t,L4 0 `I Fat-cili?rs3P(ene:1E-44-)14 `--13-2_- .S- 4 +s-- I 061 t ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID 1 Number, 10. Containers 11. Total 12. Unit 13. Waste Codes Hm and Packing Group (if any)) No. Type Quantity Wt.Nol. 1. 0 - ?LS? i\ A-1,17 „, fz..ov,,c li.)A5r-E, Ot...- .1 2_ bv14 g-170 P 2. 3. 4. 14. Special Handling Instructions and Additional Information 00 tT • MOL, 2.:& • Ov'61- `•11-C.,. 'T-- Sa, Ar '2:1 `a t 1 t %'142-C- '-1k CF-x.-Si ) 'T I 1 62-2-10tcr 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, aid are classified, packaged, marked and labeled/placarded, and are in all 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) Of I am a small quantity generator) Is true. Generator's/Offerors Printed/Typed Name oik _../ X•e-r-4,11._F- Signature Month Day Year JLe----;_r 1-3,...t ---- I 9 IoIz2. 't.) 4e=f4;20..4.7-0$. cr-r-.AC-31-1.• r Co - f-- 16. International Shipments LI Import to U.S. Export from U.S. Port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: FN 17. Transporter Acknowledgment of Receipt of Materials TRANSPORT! Transporter 1 Pnnted/Typed Name Signature Month Day Year 3011n../ g I I 1 I 3C) I 2:). Trans rier Printed/Typed Name ligriarre Month Day Year idio I/Y-4I 2L DESIGNATED FACILITY 18. Discrepancy Discrepancy Indication Space III Quantity Type LI Residue Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I 18c Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) . Il 1 /iii 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Name Signature Month Day Year .....------ I 4 Irr) I_ 2-.. I) 0 I /O 17--Z- EPA Form 870 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM