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Please print or type. Form Approved.OMB No,2050-W39 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page I of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR000220046 1 909-984-9984 017231602 FLE <br /> $ t than mailing address) <br /> GAL!WffIA f HE�4L'�R CARE FACIT.TIY (07557) 7707 S�UTIf AUScriffeTIN (ROAD <br /> 7707 SOUTH AUSTIN ROM {attn: M. wh1st1c STOCE1p8, CA 9521.5 (attn:marbc whistler) <br /> STE]=MH, CA 95215 <br /> GeneraloesPhone: 70o 467-7Qi14 <br /> 6.Transporter 1 Company Name U.S.EPA ID Humber <br /> INDUSTRM 'WASTE U'I'II.ISATIO6, INC. CAD980505293 <br /> T.Transporter 2 Comparry Name U.S.EPA ID Number <br /> Bus ig?ted Frap�Tity_NYame MOAdNd, INC U-S.EPA ID Number <br /> 5-375 S. FOYLE AVE. <br /> VE-P-MON, CA 90058 <br /> Facility's Phone: 323-277-1500 CARD 97930993 <br /> ga 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(if any)) No_ Type Quantity WUVd. <br /> 1, Ub1JLUvU, ldai2tc Acetone, , D001 U002 21.2 <br /> ax <br /> v � <br /> C <br /> 2 2. <br /> w <br /> t7 <br /> a <br /> 4. <br /> 14,Special Handling Instructions and Additional information <br /> I) Acetone ct1661829/app§657274; ERG 0: 127 <br /> 2z`+r6z <br /> 1 . GENE 0WSIOFFEROR:S CERTIFICATION:I hereby declare that the contents of this consignment are furry and accurately described above by the proper shi*hg name,and are classified,packaged, <br /> marked and labeled/placarded,and are in an respects in proper condition for transport according to applicable I emallonaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAckrrawledg t rhsent. <br /> I certify that the waste minimJzADn statement identified in 40 CFR 2622T(a){if I am a large quantity gene or (ill a eall quantity generator}is we. <br /> Generator'swe is PM" 5g Month Day Year <br /> 1 At <br /> •� 16.ince national Shipments <br /> ❑Impart to U.s. ❑Export from U.S. Pan of eotrylexik <br /> ? Transporter signature(for exports onty): Data leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> H Transporter i PrinWVyped Name S- Month Day Year <br /> a I L 11I A9 IOU <br /> Transporter 2 Printed/Typed Name Signature Month Day Year <br /> F <br /> I&Discrepancy <br /> t9a Disaepanuy Ind cation Space ❑ Guanlay ❑Type ❑Residue ❑Part al Rejed en ❑Fun Aejeclion <br /> Manifest Reference Number- <br /> 18b.Aftemate Facility(or Generator) U.S.EPA ID Number <br /> 1 <br /> V <br /> ti Facility's Phone: <br /> uj W Signature of Alternate Facility(orGeneraiof) Month Day Year <br /> 4 <br /> 2 <br /> N19,Hazardous Waste Report Van gement Method Codes O.e.,codes for hazardous waste ueaiment,disposal,and recycling systems) <br /> LU 1. 2_ 3. a. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazard3us materials covered by the manifest except as ncted in Item 18a <br /> Phntedlryped Name Signature Month Day Year <br /> �Su. 12 v ZZ <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete, DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />