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Please punt or type..(Form designed For u on elite(12-pltchj Typewnter. " f <br /> } F&hn Approved.OMB No.2050-0039 <br /> UNIFORM KVMDOUS J.Genesettir fD Number. 2.Page.1 of 3.Emergency Response Phone 4.Manifest Tracking Number. <br /> WASTE MANIFEST C�A D 9 8 2 0 8 2 5 I � ' "9139-889�5r�07 0 0'0 2-5 2:�.2 fi JJ K _ <br /> 5.Generators Name and Mailing Address. Generator's Site Address(it different than mailing address)_ <br /> UrAed Weste[rt^�,,,. ; <br /> vl aw�Gt"�J -. � � - <br /> U.w.©. <br /> :A� atCert ,5�0Sheila St �� `1990 Piccoll Rd, • <br /> CWtrrterce CA 90D40 -`. �' . - 5'tocittan CA 95215 <br /> Generatcr's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA!D Number <br /> Hae Mat Trans,'Inc. C 'A T ' '$ . : $ :Q <br /> 7.Transporter 2 Company Name, U.S.EPA fD Number <br /> 8.DesignatedFacility Name and Site Address U.S.EPA 1D NumberSlams Water Tomes Corp <br /> 5375 SoUM"Ave. . <br /> Ven= CA 9#)M <br /> Facil' s Phone: C A D 0 9 ❑ 9 9: ... <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1t.Total 12:Unit <br /> HM and Packing Group(if any)) No. Type antity WWoI. <br /> 13.Waste Codes <br /> Qu - _ <br /> W 1. Nor Hazardcws Waste Solid Z: <br /> Dm P, <br /> z 2. <br /> S <br /> 4. <br /> 14.Spadal Handling Instructions and Addltlonal Information A <br /> "oil/,dirt/absorbent— `Profile #1:6838 ;. � J t Gloves & :Gaggles ... .. . <br /> 15. GENERATOR'SfOFFEROR'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 labeledlpiacarded,and are In all respects in proper condition for transport accorftq to applicable International and natlo4 governmental regulations.If exporl.shipment and I am the,Pdmary' <br /> Exporter,I certlfy 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)or(b)(if l am a small quantity generator)is true: ' <br /> Generator's! ror's Prnted d Name Signature Month Day :,Year <br /> 16.International Shipments, Export from U.S.. Port of enbyfexit <br /> F <br /> Import to U.S. ❑ <br /> x Transporter signature(for exports only): Date leaving U.S.:' <br /> W 17.Transporter Akdknowledgment of Receipt of Materials = <br /> Transporter tPrinte !Typed Name Signature ; Month - "Day .Year . <br /> 4 <br /> Q Ira iter 2 Printediryped Name _ Sign atu l77 <br /> onih Day Year <br /> 18.Discrepancy t <br /> 18a.Discrepancy Indication Space El Quantity 0 Type -.0 Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number. <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> Faaliys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) f,k Month Day -Year <br /> 1g.Hazardous Waste Report Management Method Codes(i.e:,codes for hazardous waste_treatment,disposal,and recycling systems) <br /> LU 0 1 2. 3 14.., <br /> 20.Designated Facility Owner rotor:Cartifioativn of receipt hazardous materials covered by the manifest except as noted in k <br /> PrintedlTyped NameLh Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERA R <br />