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Please print of type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator IDNumber 2.Page 1 of 3.Emergency Response Phone 4.Man'dest Tracking Number <br /> WASTE MANIFEST C A L 0 0 0 2 9 1 9 2 2 800) 424-9300 008145484 J J K <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> PAPE MACHINERY INC-FRENCH CANE' 6U1 S EL DORADO STREET <br /> 6621 S EL DORADOCA 95231 ENCH CAM' CA 95231 <br /> F5E ICH CAM' <br /> Generata s e: <br /> 6.Transporter 1 Company Name U S.EPA 10 Number <br /> CAD 0 2 8 2 7 7 0 3 6 <br /> 7 Trenspo er o pEany Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U S.EPA ID Number <br /> SIEMENS WATER TECHNOLOGIES CORP. <br /> 5375 SOUTH BOYLE AVENUE CA 90058 C A D 0 9 7 0 3 0 9 9 3 <br /> LOS ANGELES <br /> Facility's hone: 777-16M <br /> ga 91b.U S DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> P (� 9 mP PP 9 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> NON-RCRA HAZARDOUS WASTE, SOLID(OILY SOLIDS) D M �v v P <br /> Z 2. i <br /> W i <br /> i <br /> 3. <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT! CHEMTREC 1800-124-9300 NAERG#9B1 : 171 *PROFILE#9B1 :AP176611 OILY SOLIDS'PO# <br /> A11013M7,APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this 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(a)(if I am a large quantity generator)or(b)lift am small quantity generator)is true. <br /> GeneralorslOffem s Printed me Si ature M th �y Y r <br /> -j '16.Intemafioip entsU <br /> Import to U.S. EJ Eos Prem Expos U.S. Port of a rylexit -_- <br /> Z Transporter signature(for exports only): Date le ing U S.: <br /> W 17 Transporter Acknowledgment of Receipt of Materials <br /> Trans 1 Pdnte y Name Signa; "!°° Ye r <br /> O <br /> a <br /> Z Trans rter 2 PrintedrT d me SIT are Month Day Year <br /> a <br /> 18 Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Refection <br /> Manifest Reference Number, <br /> 18b.Atemate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facilitys Phone' <br /> W 18c.Signature ofAltemate Facility(or Generator) Month Gay Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,axles for hazardous waste treatment,disposal,and recycling systems) <br /> 1 2. 3, 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />