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rt�to� IG A59p1 (a) *� <br /> ,� type.(Farm designed for use on elite(12-pitch otter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Numher <br /> - WASTE MANIFEST I i 006487360 JJK <br /> 5.Generator's Name and Mailing Address Genera is Site Address(ii different than mailing address) <br /> I <br /> General <br /> ors <br /> +rrf _l <br /> Phone:Uf <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> r <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> I.Designated Fill llty Name and Site Address 9 U.S.EPA 0 Number <br /> NA( Tf'It: RES0110l € ECOVERY <br /> i r,r <br /> FAST PICA BI VD- <br /> 10"r ANiI'.I.E`"x, CA 9W)t'3 <br /> Facility's Phone: (fW,'k%A 7 A.QI) 7,f H r., <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,0 Number, 10.Containers 11.Total 12,Unit <br /> HM and Packing Group(if any)) No. Type Quantity WLNoI. 13.Waste Codes <br /> x ltifdi 'r,A, L)ASrTF. PAINT REk.ATl MA'ffPTAi. , <br /> O i'(,TI, RQ, (()C a'1 3 <br /> q� t}M <br /> w 2IV(;rN--fel-kHA ,ARDOU1S-WA II :. lTl?tIL0.-4bJtalEtiStLlk2NE---- 7 <br /> c7 G-k-FANFNFa—a.4#1,-13T-1f3PL1--f-L'.A7. ffRtJ:7-A---R- l�4t-Alf.-Ii.--..... .. _ <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> ?ly1 ) 11 6'32'1ild i"8-- <br /> GI C1VFS;,, (401101 E'lr & PRt1TE:f'(TVE r1.OT'Wrm <br /> IPC,0. 9b1 ') I.'yt 41 � <br /> TRANS",POFtTEG 1 Pti0Nf7 N <br /> 15. GENERAMWSIOFFEROR'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 will that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)cur(b)('TI am a small quantity generator)is true. <br /> Generetorsl0gerors Printed/Typed Name Signature Month Day Year <br /> i ter r k i '' �( i'/ ,1"1 / <br /> � 1'61`ntema8onal Shipments <br /> - {�..r° <br /> ❑Import to U.S. ❑Export from U.S. Portofentry/exit: <br /> Transporter signature(for exports only): Date leaving U,S.: <br /> w 17.TransporterAcknowtedgment of Receipt of Materials - <br /> Transporter.1.Printedl it Name Signature Month Day Year <br /> O <br /> M <br /> Transporter 2 Pdntedlfyped Name. Signature Month Day Year <br /> C <br /> F <br /> I <br /> r 18.Discrepancy <br /> 18a.Discrepancy Indication Space Elpuanfi y El Type 1:1 Residue ❑Panial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> r 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes 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 noted in Item 18a <br /> PrinledRyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />