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S Please prig or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 1 3.Emergency Response Phone jl 4.Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 4 0 7 0 3 0 1 510-582-6181 026206946 JJ K 5.Generator's Name and Mailing Address ft TOM Robins Generator's Site Address(if different than mailing address) United#5447 United V6447 4130 Caner Suet 1469 E Hammer LNl.. Lang Beach CA 90808 Stockton CA 95210 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number BmAw dndusWJ dim,Inc ICAR00034 7 4 9 2 7.Transporter 2 Company Name U.S.EPA ID Number I CImm Hemdom. WaaW Remmol 8.Designated Facility Name and Site Address U.S.EPA ID Number US ECdoffif Mew Highway 95,11 South of Beatty Beft NV t3om Facility's Phone: dot V Tr 3 3 0 0 1 0 0 0 0 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. lJPJ132v,wAS rE Flan►tft� d ,oa �n�,�.� ®1 V 4.1,PGdI(GIne) ®M P LI 3. 4. 14.Special Handling Instructions and Additional Information Ijietrts dmpactad vft Saadine.ProBief#070316557-0. ERW433 hwoLn dLq t�94 ruJill RM,iuo.JOB 2480M. CORS#231714 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,and are classified,packaged, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if l am a small quantity generator)is true. Ge erat is/Offeror's Printedfryped Name p Signature Month Day Year �`� 16.International Shipments F ❑Imps to U.S. El Export from U.S. Port ofentry/exit: � ? Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Dav Year o Mick d a 04 z Trans orter 2 Printed/Typed Na e ( Signatures 2 Mon h Day Year 18. iscrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type yp El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J C) LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU G 1. 2. 3. 4. M �A,� 1 20.Designated Fa ility 0w4 or Operator:Certification of r ceipt of hazardous materials covered by the manifest except as noted Kem 18a Printed/Typed a Signature Month Day r EPA Form 8700- (Rev.12-17) Previous editions are obsolete. D GN ED FACILITY TO EPA's e-MANIFEST SYSTE