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n T Q C n�0')-7 1 ZCA Please print or type. (Form designed for use on elite f 12-oitchl tvoevariter.) Fnrm Annrnvpd r1MR Nn W)Qr nao EPA Form 8700-Z2 (Rev. 305) Previous editions are obsolete. 12415.0079 DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number WASTE MANIFEST ci-wc/U"31- 3 Ci 3 2. Page ge i of 1 3. Emergency Response Phone ��1, 31 4. Manifest Tracking Number H2500086 .G B F 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) Vvi"ll t9 Generators Phone: �� 6. Transporter 1 Company Name U.S. EPA ID Number Kern p 19 l C-lig "tom C/o o 2i 4 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site drrejs U.S. EPA ID Number 2`V.0 Facility's Phone: ga HM 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, and Packing Group (if any)) 10. Containers 11, Total Quantity 12, Unit WI.Nol. 13. Waste Codes No. Type 'n �v)4� T '`'` 24> 3S2 r 1 ^i01 io-bsc v . a 2. W (.7 3. 4. 14. Special Handling Instructions and Additional Information wild Kra-ya-il i'� 2 �°11�1�v-b��T� 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dec are 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 EPAAcknoWedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (f I am a lame quantity generator) or (b) (if I am a small quanttyenerator) is We. d/Typed Name Si nature Month Day Year Generator�es Pni / -J iF 16. Intematiol Shipments ❑ Import to U S ❑ Export horn .S. Part of enbylexit Transporter signature (for exports only): Date leaving U.S.: IX W 17. Transporter Acknowledgment of Receipt of Materials 0gw' Tans it 1 Pdnted/Typed Name Sign ure '*- M th y Year N Q Transporter 2 Pnnted1Type4 Name Sin re Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑Full Rejecton Manifest Reference Number: P 18b. Alternate Facility (or Generator) U.S. EPA ID Number J_ Ci LL Facility's Phone: W 18c. Signature of ARemate Facility (or Generator) --11Q Month Day Year Z N19. Hazardous Waste Report Management Method Codes (.e., codes for hazardous waste treatment, disposal, and recycling systems) o, i��`� 2 3. 4. 1 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a Printed/T_ Wame� � Signature Month �� Year �j /J EPA Form 8700-Z2 (Rev. 305) Previous editions are obsolete. 12415.0079 DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)