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.; F : Form Approved OMB No:2050-0038, Please pent or type.(Form designed for use bn elite(12-pita wnter) UNIFORM HAZARDOUS 1.Generator lD Number 2..Page 1 of,,3.Emergency Response Phone 4 Manifest Tracking Number �( WASTE MANIFEST 909-815607 ��!<1l 5.Generator's Name and Mailing Address Generator's Site Addres025-0479 , s(if different 1han,mailing address) ' Untied Wastf m G06C61 s" 990 f�Mcco1 Rd. 1 Attn: Pat C riTae�r,5200 Sheila Street-; Commerce.CA 90040 Stoddon CA 96215 Generator's Phone: ; r2 '6 4 6.Transporter 1 Compan e.el' U.S.EPA ID Number { M-t MVM V'. grans Inc. " U.S.EPA ID Number t 7.Transporter 2 Company Name '. i 8.Designated Facility Name and Site Address U.S.YEPAiD Numtrer Siemerfs Water Techrmlogies Corp• 5375 Sotfth Bayle Ave- Facts Phfo°n�e CA 90058 9a. 9b.U.S.DOT Description(induding Proper Shipping Name,Hazard Ciass,.ID Number, 10.Containers 11.Toial 12.Unit 13:Waste Codes I HM and Packing Group(if any)) . - No. Type -C uantity Nivol. Non-RCRA,HazardouS Waste Solid " h 3 r 4. 14.Special Handling Instructions and Additional Information , `� Glcaves & Go lei 1 9b:1) : dieselfoi�/dart/alisrarkrent- Prefile #P1654A'lP 99 j �0 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents ofthls omisignment are fully and accurately described above by the proof shipping name,and are classified,packaged, merited and labaledlplacartled,and are In all respects in proper condition for transport according to applicable intemational and national governmental regulations,It export shlpmerd andel am the Primary Exporter,I certify that the contents of this oonsignmeni conform to the terms the attached EPAAcknowledgment of Consint z I carfNy that the waste minimization statement identified in 40 CFR 262.27(a)(if t am a targe quantity generator)or(b}{if I am a small quantity generator}is true Generator' rods Prints yped Name Signature ondr Day Year 16 International Shipments rt from U S Port of entrylexit ❑Import to U S, El 'Date U.S. _ 9 n iter si nature for exports onl -Transporter yJ• Po 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PdntedrTyped Name Signature Month . Day.': _Year IZ rn Month Day , Year C Trans_ rter 2 Pdntedfryped Name gna 18.Discrepancy - 16a.Discrepancy tndication Space. -„ ❑ Quantity ❑Type y ❑Residue ❑Partial Rejection ❑F¢II Reledlon -`; Manstest Re ference'Number: 18b.Alternate Facility(or Generator). U:S.EPA ID Number Facility.Phone: r 18c.Signature of Altemata Facility{or GeneraLU tor) _ Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) T " g 4. G 1, 2•- 20-Designated NAY Dwner or greritor.Certification of racei h us materials oavered by the man Kest except as holed in Ice a - PrinteCypedName: r Signature d Month Day Year DESIGNATED-FACILITY TO GENERATOR EPA Form 8700-22(Rev.3-05) Previous editions are ob o eta.