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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifestTrackin'33178 <br /> Number <br /> WASTE MANIFEST CAt 0 0 4 5 3 317 8 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CENTRAL SPRh%r;, trYt; <br /> 48 tri 50fFING WAY <br /> "TOCKTC*4,CA V5203 <br /> Generator's Phone: <br /> 6 Transporter f Company ne U.S.EPA ID Number <br /> f Rf-& XM ENVIRrI`p:NTAI. ;iFRVECES tart- Phcutu it 8011.559-3274 CAiitM 11 111,11i <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> GEM Rancho Cordma LLC CAC 3$t38£3A It1) <br /> 1106V*ft I oCk Rt3ad <br /> RIluiwho Cordi>a+s.CA 9574?MA <br /> Faali sPhone: 91&351-098f3 <br /> 9a, 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, to-Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group('4 any)) No. Type Quantity Wt1Vol. <br /> O 1- l**-RC-RA FIamrdws'YVaSt* (Fillet Cakeo :*A P 181 <br /> C)() <br /> W <br /> z z. <br /> W <br /> c� <br /> 3. <br /> I <br /> 6 <br /> 7 <br /> 4. P <br /> 14.Special Handling Insiructions and Additional Information <br /> I-iRNDLER-S 1C3 BE 401-IR TRAO&O ANV WEAR PPE'. <br /> 9BA)R 18395 ER[39 171 <br /> 5. GENERATOR'SlOFFERO 'S CER KATION: I hereby declare that the contents of this consignment are fully and accurately descr bed above try the proper shipping name,ab are classified,packaged, <br /> marked and labeledfplacarded,and are in all respects in proper condition for transport accor&q to applicable intemationat and nationa4 goverrmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the content&•of ft consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quaintly generator)or(b)(if I am a small quantity generator)is true. <br /> Giaq&h)S10Ws PrintedrrypoName Signature Month Day Year <br /> -1 16 R temational ipmen + <br /> ❑ <br /> ❑Impart to U.S. Expert from U.S. Port of entrylexil: <br /> = Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> 'Ua[spo er1Printed/T arae Sig hr Month Day Y�j <br /> a 1 +� ;l X <br /> an - <br /> Z pfxterzyped Nwrd "*Aiftre th bay ear <br /> ec <br /> 18.Discrepancy <br /> 1aa.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Pad al Rejection ❑Full Rejection <br /> Manifest Reference Number- <br /> I8b.Alternate Facility(or Generator) U.S EPA ID Number <br /> J <br /> tJ <br /> Facility's Phone: <br /> w 18c.Signature of Aflemale Facility(o Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes{i.e.,codes For hazardous waste treatment,disposal,and recycling systems) <br /> O 1. 2. 3. 4. <br /> 24).Designated Fasifily Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnntedfryped Name *nature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete, GENERATOR'S INITIAL COPY <br />