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i Please print or type. Form 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 ;1k UUU40Uj(: 00 i' % -' 826 DAT 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) :Ify of If fb4 y YY:rst+aWatdf Labors )ry ATTN:GobrW Duwtt �400 HAy Dr Generator's Phone: 209-8i 11-6318 6.Transporter 1 Company Name U.S. EPA ID Number 7.Transporter 2 Company Name U.S. EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number . I,l:dzi�8089&33$ rlewlarrcla Ur tcasi Facility's Phone: 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. Oti441J44 4,+NA8TE A MIAODl1UM PERSULFATE, 6.1, PG 10, ERG 140 9 z 2. LU UN1805, WASTE PHOSPHORIC ACID, SOLUTION, 8, PG III, ERG 154 3. UN 1493, WASTE SILVER NITRATE, 5. 1. PG It, ERG 140 4. 551 UUU1 UUOJ UN1:.�1, WASTE 9Cx71UM 0lTHIONITE. 4.2, PG il, ERG135 r L . � 4 1 14.Special Handling Instructions and Additional Information k.; i, I ;r.>r ;;I.),1)"",,vvI I r , u�t: i ;_L. 1 :;r.; 112 03: (1d7193.5YAWN3 ! SFAi3O" 150 H2 02: f 1t171f1;<;)>nfydi)? "A/A'I 1fl-A. I 1 H*` 04: ; INC15-IY,? / fit H2 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 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 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)(if I am a small quantity generator)is true. Generator's/Offerors Printed/Typed Name Signature Month Day Year 16. International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed(Typed Name Signature Month Day Year O CL z Transporter 2 Prmted/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ty ❑Type ❑ ❑ f ❑Full Rejection Quantity Ty Residue Partial 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 a z 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 20. Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY