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Please printor typo.(Form designed for use on elite(12-pitch)typewriter.) <br /> UNIFORM HAZARDOUS 1.Generator ID Number —M--W:5::1: <br /> Form Approved.OMB No.2050-0039 <br /> 2.Page 1 of 3.Emergency Response Phone 4.Manift Tracking Number <br /> WASTE MANIFEST - 013083184 JJ K <br /> S.Gen <br /> aatcls Name and Mailing KS Generatols Site Address(a dish rent than mailing address) <br /> � v�0�s1s <br /> Gene <br /> L, +t,:rl TL TX 77873 2373 E 1MARIPOSA ROAD <br /> mb+a hone: -Company Name 51 CA, "2015 <br /> B.Tmnsporte <br /> U.S.EPA ID Number <br /> �R. , ti <br /> 7.Trans' 2Company erne - - <br /> U._._ I Number <br /> 8.De <br /> e�si <br /> g <br /> rn <br /> yat <br /> teed Faality Name and Site Address ZQ IU <br /> B981JA WATjR TEt LUGIES LLC U.S.FPA ID Number <br /> Xh"1/U SOUTH OYI.E A NUF <br /> q�y LES CA 90ma ENVIRONMEprpART NTAL HEALT <br /> Foci shone: ENT CAD097030943 <br /> 9a. 9b.U.S.DO Description(including Proper Shipping Name,Hazard Class,ID Number, 10.0 ontainers T12.Hand Paddng Group('rf any)) No. Type 13.Waste Codes <br /> N'O: ACRAHA.�ARDOUS WAFSt?LIC•s a r c r p,. SDLIDS' <br /> D M <br /> 2 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instrugtions an Additional Information I <br /> FMFR(;ENG'Y 00NTACT CHF.MTREC 1.600-424.9300 NAERC+A 991:17 . ° PROFILE#981:AP a 8 i 59 OILY <br /> SOLID6; ABSORBENT,SWEEP* PON A�4iO1N9031APPROPRIATE PERSpNAL PROTECTIVE.EQUIPhtkNT <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and acoumtety described above by the proper shipping name,and are detailed,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 comity that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(81 am a small quantity generator)is We. <br /> Genenitofs/Offemes Printed7fyped Name Sgnatum Month Year <br /> � 16.Intemafional8hipmenta <br /> F-' .y <br /> r]Importto U.S. ❑Exp dtfmm U.S. Pon of entry/exit: <br /> Transporter sgnature(fap exports only)' - - - - --.--.- <br /> -Dateleavlhg 118.1 <br /> W 17.TramPorterAcknowledgment of Receipt of Materials <br /> TmnsPortef 1 Printaffyped Name <br /> O Signature Month Day Year <br /> Go <br /> Q Transporter 2 Primed/Typed Name •, . '.. .. ✓ "'" �. ' <br /> C Signature Munch Day Year <br /> F- <br /> } 18.Discrepancy <br /> I las.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue <br /> EJ Parts]Rejection ❑Full Rejecdan <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number U.S.EPA ID Number <br /> J <br /> (.l <br /> LL Facilitys Phone: <br /> W 18c.Signature ofAltemate Facilily(or Genemtar) Monty Day Year <br /> Q <br /> 2 <br /> ly 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,dis <br /> pcsal,and recycling systems) <br /> 1. 2' 3, 4. <br /> 1 20.Designated Facility Owner or Operator.Certification of recept of hazardous materials covered by the manifest except as noted in Item Ise <br /> Pdnted4yped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />