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y <br /> Please print of type.{Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1Generator ID Number 2.Page t of 3.Emergency Response Phone4.Manifest Tracking Number <br /> WASTE MANIFEST lt ' "s I h1 Ty+ n04533058 JJK <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> S.:lfdTR.':i.�idf�t:`1r'.Si•.i�t. <br /> trv18 E`i5;2?IW1:a W w, <br /> fflicPi l sll.G." <br /> Generator's Phone: <br /> 6.Transocular 1 Company We U.S.EPA 10 Number <br /> FRF14ctil EhJ'JACAll 9ar1i ING. t"'foll i1t°t41 ..2;1 Grt1ZO O r'313aI <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facifily Name and Site Address U.S.EPA ID Number <br /> r:,;J5&l IRMIC-li"Oil LLC <br /> f 1 �Ilit��fi RI>�€1 l;,aF1WW�3d?4� <br /> '!riil4f'ft?COMOUB,CA Wi 4`a tJu? <br /> Facility°sPhone: 'ftf t'I tPxJ <br /> ga. 9b.U.S.DOT Desrrsptkn(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11.TOW 12 Unit 13.waste Codes <br /> Packing HM and Group(if any)) No. Type Quantity WLNol. <br /> a <br /> 1. Ili,rs•f!t.t;:�P-I�Z134't�iiJ�'•'�ialg, sfYfa9 rl"tt_1`#»t=' �:.Kf�s1:�� t7�,a t.-r <br /> -4 .J <br /> { <br /> Z 2. <br /> UJI <br /> 3. <br /> 4. <br /> j <br /> 14.Special Handling Instructions and Additional Information <br /> rlKoitlt.L'I@s"r 1 C r IE At} 1 R.Ill 440 du'E P F*r,,E' <br /> -attr'.d R13'i! Eftl;; <br /> 15 GENtERATOR'SJOFFEROWS CERTIFICATION:I hereby dedrare that the contents of this consignment are fully and accurately described above by the proper shipping name,anti are classified,packaged, <br /> marked and labeledlpiacarded,and are in all respects in proper condition for transport according 10 applicaiafe international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,t certify that the contents of this consignment conibrm to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> G VsJOfferoes PrintedlTyped Name Signature Month Day Yaar <br /> 16.Irtleniational5 ants <br /> it Import to U.S. ❑Export Ir U.B. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Matenals <br /> LLI <br /> Tran!T <br /> 1 PrintedrilyoRiVarre R Signa at Month Day Year <br /> �('` ^� `k f'• -•- .ice �-'? i�� <br /> m 7'MrIetlFrypedi Month Day YLai <br /> d' <br /> H <br /> 16.Discrepancy <br /> 18a.Discrepancy indication Space <br /> ❑ Quantity El Type El Residue ❑Partial Rejection ❑Fuil Rejection <br /> Manifest Reference Number <br /> i 18b.Aaemate FaaRy(o Generator) U.S.EPA 10 Number <br /> J_ <br /> V <br /> I l Picone: <br /> C3 18c-Signature Dfi6ternate Facility(or Generator) Month Day Year <br /> tR <br /> Z <br /> 19.Hazardous Waste Repot Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> T.— 2 T <br /> 4. <br /> 20 Designated Facility Owner or Operator:Certilimion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> P*ted Typed Name Signature Month Day Year <br /> EPA Form 8700-22(1 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />