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RECEIVED <br />Please print or type (Form desioned for use on elite f12 -rite„ n,rewn1er t <br />EPA Form 8700-22A (Rev 3-05) Previous editions are obsolete DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21. Generator lD Number <br />22 Page <br />rwwvw. UinD IVU. [UDU-UUJy <br />23. Manliest Tracking Number ZUK <br />(CondnuationSheet) <br />�—r <br />CA.2890040002 <br />7 <br />.14 <br />24 GeneralorsName Lawrence Lfinel7710re NatlOnal Latl01110rr Site 300 ENVIRONMENTAL HEALTH <br />P.O. Box 806 L-765 <br />Uyermom CA 94551 DEPARTMENT <br />25 Transporter Company Name US EPA ID Number <br />26 Transporter _Company Name U S EPA ID Number <br />27a <br />27b U S DOT DescdpWn (including Proper Shipping Name, Hazard Gass, ID Number, <br />2B. Contakrers <br />- <br />2g'Total <br />3p QM <br />HM <br />and Padung Group (d any)) <br />QuantityWWd. <br />31. Waste Codes <br />No. <br />Type <br />55. Non-RCRA hnzardouswaste, solid (resin beads) (DOPOULP) <br />2 <br />D" <br />776 <br />P <br />56. Non-RCRA hazardouswasm.. solid (Spent ca ton) (DOP0032A- <br />— <br />1) <br />10 <br />DSS <br />3508 <br />P <br />57 Consumer commodity, ORM-0 (aerosols) (ERG 171] <br />(DOPO 112-1) <br />2 <br />DE <br />21 <br />e <br />— <br />- — <br />0 <br />58. Yea», Consumer commodity, ORM-0 (aerosols) (ERG 171) <br />(DOPOM-1) <br />DO <br />- <br />ty <br />2 <br />172 <br />P <br />13901 <br />z <br />59 Waste, Consumer conitnodity, ORM-0 (aerosols) (ERG 1711 <br />(00P0112-11 <br />1 <br />Dr <br />7 <br />P- <br />- <br />D002 <br />32 Special Handling InstnKlions and Additional Informabon <br />0. <br />33. Tronspoeer menl of Receipt of Matenals <br />�tr <br />Z34. <br />Pdnted/Typed Name Signature Month Day Year <br />Transputer _ _ _ Aduv.wledgment of Receipt of Matedals <br />Printed/Typed Name Stgnature Month Day Year <br />35. Discrepancy <br />Q <br />Q <br />LL <br />Uj <br />iL <br />36 Wa Report Management Method Codes Cie, codes for hazarddra waste treabrtent and w yding systems) <br />Z <br />1w I H1y-� <br />W <br />LHazardous <br />D <br />EPA Form 8700-22A (Rev 3-05) Previous editions are obsolete DESIGNATED FACILITY TO GENERATOR <br />