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VV 044 Please print or type. Farm Approved OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator Id Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackln Number WASTE MANIFEST CAR000220096 1 01817008 FLE 5.Generators Name and Mailing Ad dress - Generators Site Address(11 different than mailing address} CA.LIFORBIA aTH CARL FACILITY 017557) 7707 SGUTs AUSTlE ROAD 7707 SOUTH AUSTIN ROAD (attn= Ci- whistle 9=kTOW CA 95215 (attn_nmrlr, whistlery STOCRTOF, CA 85215 Generators Phone: 2inQ 4G7-7 CO n4 6.Transporter 1 Company Name U.S.EPA ID Number INDUSTRIAL WASTE UTILIZATION, INC- CAD960585293 7,Trans 'ter 2 Company Name U.S.EPA ID Number e &1A onos 8i"TIeU?W` VVnE , NvwNTAL - OF FEVADA,LLC U,S,EPA ID Number 2095 NEWLAND5 DRIAE EAST FERNLEY, Ne 69908 Facility's Phone: 775-575-2760 tTVD980695336 ga. 9b.U.S.DOT Description(fncfuft Proper Stepping Name,Hazard Clava,3D Noe fiber. 10.Canlairrea 11.Total 12.Unit 13.Wada Caries HM and Packing Group(A any)} No. Typo Quantlty WtNot I. 5&k- P,;T I P,:SI w z 2 trt� 31, {�Fi, .diGLCiR k}�- -.r-Q•s��es- eNceexiixtg I L capacity)), 2.2 �31 14.Special Handling Insln.icticne.and Additional Information — 2 7cr— `a 3) LP peppez spray aerosols--"' - End '_ 126 15. GENERATOR'SIOFFEROR'e CERTIFICATION:I hereby declare that the conlenls of this consignment aro fully and accurately described above by the proper shipping name,and are dass€fied,packaged, marked and Iaheledlplaramed,and aurin all mspece;in prcper condition for transport accorcia4 to appiirabte inlemalionaland natural governmental regulations.if export shipmenl and I am the Primary Exporter,I certify that the contenls of this consignment conkxm to Ne farms of tha attached EPAAcknowledgerenl of CO nt. I certify Mat the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quandty genera r(b} am all quamitygenamlor)is We. Genera€orsiOlferces Prinledayped Name Slg Month Day Year 4 A, 16.Inlamahonal Shipments 911 ❑Import In 11,5, ❑Expad foam U.S. Podcf entiylexit ? Transporter signature{for exports only): Dale leaving U.S., W 17.TransporterAckricMedgmenl of Receipt of Materials Frans r 7 PdntadyTyped Name Signalwe _ Month Day Year Cell A ramp rter2 FflntedlTyeed Name Signature Month Day Year Oil �Z 28 z 18.Discrepan 18a.Discrepancy Indicalion Space ❑Quantity ❑Typo ❑Residue ❑Perm Relectian ❑Full Rejection Manifest Referenoa Number: 18b.Remale Facility(or Genemlur) U,S.EPA 1D Number J U sac FBCiftly'S Phone- w18c.Signature of Altemate Facility Eu Generator) Month Day Year a CD N19.Hazardous Waste Report Management Method Codes{.a.,0988 for halandous waste tres"enl,disposal,and reeyding systems) G 1. 2. 20.Designated FacAly Owner or Operator.Certification of tempt of hazardous maleriaiscovered bythe manifest excepl as nded'm Clem 18a PrinledlTyped area Signature }I Month DAM= I ay Ye a 2 EPA Form 870V-22(Rev.12-17) Prbvibus editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIF ST SYSTEM