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4 <br /> Please•print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.©MB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genaretar ID Number 2.Paged of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST -C A D 9 8 2 5 0 8 % rk . 1 �7 -t��s(7.!�B�i 00022917 55JJ K <br /> 5.Generators Name and Mailing Address Generators Site Address(I different than mailing address) <br /> t ntttedt 1i98t'eR'I C4V(. ,S u 4/ 'G <br /> Alit} Fiat C-Ai ur'r'nety,6"no Sill Sti l 1GY0 Piccc* Rd <br /> Generators Phone: ti - r, r 7 <br /> 6.Transporter 1 Company ame U.S.EPA ID Number <br /> Haz Mat Trans, Inc C. A T U 8 0 1 6 0 0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Faality Name and Site Address U.S.EPA ID Number <br /> ;iiia n3C+m Wait" fechni,7lc'tG S <br /> 5375 Soull Kyte Ave <br /> Verr-+cr► CA 9tlf�t�f3 - <br /> FacilitysPhone: - A i 0Si ._ <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes ] <br /> HM and Packing Group(if any)) No, Type Quantity Wt'Nol, f <br /> Q 1. NcA--RCR,A, I-f#'iZ°,3f 1!Or118 Waste Sobd s <br /> °'r•,r t <br /> LU <br /> 3, <br /> 4. <br /> 14.Special Handling Instructions and Addt4onal informatlon i <br /> �i 1.i di 1:1- 'Aly!3r>vhry1'rt< P-.1:,I i l ti AP 3 Q °• ? - I <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 labeledlplacarded,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 EPAAcknowledgmani 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 /> Generators/Offerors Printed/Typed Name Signature Month Day Year <br /> J 116,International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Recelpt of Materials <br /> Transporter 1 Printedffyped Name Signature Month Day Year <br /> f r Month Da Year <br /> Transporter 2 PrinledfTyped Name Signature y <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ cniantity ❑Type ❑Residue ❑Partial Re)ec6on ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> � Faeiiity"s Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes p.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3• 4. <br /> F�5a <br /> d Facility Owner or operator:Certdcation of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />