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Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 E 1.Generator, N 2.Page 1 o 3.Emerge �o phony 4.Manifest Tracking Number j UNIFORM HAZARDOUS t.:.982508251 � ��],�t?4-5200 WASTE MANIFEST 000: 0 O 0 5 0.S G B.F t - 5 Generators Name and Mailing Address Generators Site Address(if different than mailing address) r - Unified.W&qte.m Gl i erg '1 ii i d Wi�eiil Gt'ac �{l) I t e c C'ctmzlnter >v C�� 0040 :i: 00 Pict all Rota-%W' Generaldrs Phvne a:.I �� ?(j i_ TlFllit ),t9t�yC.°�((J4ItiL3Tt, 8 Transporter 1 Company Name U S.EPA Ns,mbes i; 2 7.Transporter ,Company,Name ' ' f U S:EPA ID Number ; e.Designated Facility Namend Sit'Addreas U.S.EPA 10 Number 14'18"E. Maming, Parlief CA. 93649 i >S1jj 498,62410L-AL000102_-151 i Facility's Phone: - ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No Tye ty 13.Waste Codes Quanti Wt.Nal. 1. {)N ' C'J?.A Bazar ours W;.SW,,' 221 Liquid (Used ti Nfixed.()if) 2. u1 3. _ 4. I 14,Special Handling Instructions and Additional Information 1 iN.�'J?P'C"# 9131 1.71."Profile 7*B1: Used tYiV'_4ixed Oil- "ApProp'iate Persoti Protective 15. GENERATOR'S10FFEROR'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, marked and labaledfplauarded,and are in all respects in proper condition for transport according 10 applicable international and national governmental regufalions.If export shipment and I am the Primary -4,--Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if i am a large quantity generator)or(b)(if 1 am a small quantity generator)is true. me Sign �-�--^�-� Month Day Year Gene[atorsJOfferor's PrintedlTyped Na � �� 1 ; r" wi 16.International Shipments F. ❑Import to U.S. ❑Exportt-from U.S. Port of entrylexit: 2 Transporter signature{for exports only): . Date leaving U.S.: w 17.TransporterAcknowledgment of Receipt of Materials Trans iter 1 Printedfryped Name e Y Month Day_. Year O �'( i 0_ RTransporter 2 PrintedfTypod Name Signature Month Day Year r 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity w ❑Type El Residue ❑Partial Rejection ElFull Rejecton Manifest Reference Number: 18b.Alternate,Facility{or GeneraoorE U.S.EPA ID Number V .. - Facility's phone: Month pay Year w 18c.Signature of Alternate Facility(or Generator) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1' 1. 14.1 2. 3.'r 4.. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pri{{nt�ed_�l7yped Sig-"~ Month bay Year y EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. npplll9Nawn imnw rym GmllEi1OR