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F <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) " " Form Approved,'OMB No.2050-0039'. I <br /> 1.Generator ID N b r 2 Page 1 3.Emerg �.pp o 4.Manifest Tracking Number �+ p <br /> UNIFORMHAZARDOUSM1982508,..]�-. � ������a� 200 WTO <br /> 4_. G B F 1 <br /> _ WASTE MANIFEST � . 6- .5.04 ,-. . <br /> 5.Generators Name gMait(pgA dre .» Generator St Add'ess tjdiffetentthan ailing address} } S i <br /> ntz 4 �ateri " rrocers,. Lni><etem G�roc <br /> <? 0; 3ietla'Street C oniimerc.e <br /> 1�rrt�iiaf . stctea� c a r-�? 4(tar�£f , <br /> GeneratersPhone :- <br /> 6Transporter 1 Co <br /> mpany Name "+ Y U S EPAIONumber - <br /> �oasllxin�Eilt�r=�ttvevc�itl� <br /> EPAIDNumber. <br /> 7.Transporter 2 Com pany Name -U, . +• <br /> umbel <br /> 8.Designated Fac llty i U.S.EPA10 N <br /> 14287.E. -Manning, Parlier, CA, 93648 <br /> ')59i) gag s #t7 CiUM010� <br /> 751 4 <br /> Faciliys Phone: <br /> ga 9b.U.S.DOT Description{including Proper Shipping Name,Hazard Class,ID Number, t0.Cohtainers 11.Total 12.Unit13.Waste Codes. 1 <br /> HM .and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1.- ON RCT.7K 1457ardom 'aste, J <br /> .0 ._....L-iquid.(. -sed Oil/NkKed Oil) � �60 Cr <br /> z 2. <br /> W <br /> c� 1 <br /> 3. <br /> l 4. ' <br /> 14.Special Handling Instruct n_and Addi'o al Infoms on <br /> 1., Profile -'9B l: Uised (A1:11iIi ed tail Appropriate Personal Protecti%e <br /> Equipment <br /> i 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby d6ciare 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 t6rspod according to applicable intemati6nal and national governmental regulations.If export shipment and I am the Primary . <br /> Exporter,l certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent.. <br /> I certify that the waste minimization statemptidentified in 40 CFR 262.27(a)(if I am a-large quantity generator)or(b)(if I am a sma uanti generator)is true. <br /> Generatantoffe or's pri ted/Typ6d Name�/ Signature M((on��th - Day Yjear <br /> -j 16.Intemalional Shipments <br /> ❑!,port 10 U.S. ❑Export from U.S. Port of entry/exit:' <br /> Transporter signature(for exports only): Dale leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printodfryped NaT SignatMre Month Day Year . <br /> ransporter 2 Pdntedfryped Name -Signature Month Day Year <br /> 18.Discrepancy <br /> 18s.Discrepancy Indication Space, El Quantity' ❑Type ❑Residue_ ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> I'k 18b.Alternate Facility(or Generator) U.S.EPA ID Numher <br /> LL. Facility's Phone: Month Day Year <br /> 18c.Signature of Alternate Facility(or Generator) <br /> a <br /> LU <br /> z - <br /> 19.Hazardous Waste Re ort Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Ili! a 1 2 i 3 4. <br /> 20.Designated Facility Owner or Operator:Certificaton of receipt of hazardous materials covered by the manifest except as nota Item 18a <br /> NritedlFyped Name Signatur Month Day Year <br /> O 1IJ <br /> C-1 <br /> Cc. <br /> EPA Form 8700-22"(Rev.3-05) Previous editions are obsolete. ..: <br /> DESIGNATED FACILITYTO GENERATOR <br />