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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 Tracking Number WASTE MANIFEST C A L 0 0 0 4 0 7 0 3 0 1 610.582.8181 026206945 JJ K 5.Generator's Name and Mailing Address At Tate ��Generator's Site Address(if different than mailing address) Unified#6447 United 05447 4130 Caner Sheet 1460 E Hemmer LN. Lang Beach CA 90M Stacbm CA 95210 Generators Phone: 6.Transporter 1 Company-Name U.S.EPA ID Number IndusbW Se ACM Inc C A R 0 0 0 3 4 7 4 9 2 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number W*M Of R ( ) 2000 N Alameda Sheep Facility's Phone: A T ga, 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. UN19li3,WASTE FW=We liquift,wm D001 D018 343 3.PGIU 9(GUNne) ��1 DM G z 2. W LD 3. 4. 14.Special Handling Instructions and Additional Information 'I)Qae 19t�11011 hldt YY8t9r. &4 v ) ERG9928 Iftwoftdigpootof p n i l i Wt.JIM 24i3 M, C OF 'M 23171.E 15. GENERATOR'SIOFFEROR'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 intemational 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 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. Generator'/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments F- D Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAcknowledgment of Receipt of Materials LLJ Transporter 1 Printedlryped Name Signature Month Day Year fly Z&4 z4 5ETransporter 2 Printed(ryped Nam Signature Month Day Year 18.Discrepancy 1Be.Discrepancy Indication Space ❑ Quantity ❑T pe y ❑Residue El Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ L) LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4.H ON 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as not 0Item 18a Pri edlT ed Name Signature Month Year `x Vd � l s- Z EPA Form 8700- (Rev.12-17) Previous editions are ol1solete. SIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM