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Please print`or type:(Form designed for use on elite(12 pitch)typewriter.) <br /> - Form Approved.OMB No.2050-0039 <br /> 1.Generator ID Num 2'.,Page 1 of 3.Emergent Response Phone 4.Manifest Tracking Number <br /> F <br /> Dots 'B . <br /> RM HAZAR G <br /> UNIFO ""'r <br /> ��''11 `� �. . �j � X6.1208 <br /> ` WASTE MANIFEST 0 A V E <br /> Generato r n mailing aDdress} <br /> S Gener�toq Name and Mailing Address ) i { • <br /> Ltnfi cl l estetft t;roc g r: <br /> 3�t3C� <br /> 'hi ntrd °cmIt>t� 4 <br /> Genprator'�ane. - <br /> U S ERA ID Number <br /> 6 Transporter 1 Company Name. <br /> "' Satt'Jo> um'F�it R c�vclin� 14-�.� <br /> U.S._EPA 10 Number y <br /> 7.Transporter 2 Company Name <br /> 8.Designated Faciiit �lamg and SI''Addf�ss U.S.EPA ID Number 3 <br /> YsttIL1C' LL':il�ti <br /> 1.4287,E Nimining,..Parf ier. CA. 93�s�� <br /> r';4 j X1 8 0240. C.°t1LO{)t)1.i 2151 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(iriduding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Godes <br /> HM -and Packing Group(ifany)) No. Type. Quantity Wt.Not.� <br /> ?ti ON RCR.A Hazafdous Waste, � ?�� <br /> Liquid (Used oil/fixed Oil) I-T <br /> z 2. <br /> W <br /> 3. <br /> i <br /> 4. <br /> 14.Special Handling Instructions and Additional information <br /> - <br /> Wen <br /> Protective Clothing Emergency Response <br /> Contact-.San oagpin Filt Recycli1'4 <br /> (559) 498-0240 <br /> 15. -GENERATOR'SfOFFEROR'S CERTIFICATION: t 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 nationak governmental regulations.If export shipment and I am the Primary <br /> Exporter,$testify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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){!f i am a small u tty generator)is true. <br /> i Generatoesioffe s Priniedlryped Nae ` Signalu Month Day Year <br /> J 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> i a Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> � Transporter t Printed <br /> N me Signa re Month Da Year <br /> 0 <br /> 0. <br />' (n Trans orteedlTyped Name Signature, Month Day Year <br /> a p <br /> f18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Raja ctan <br /> i Manifest Reference Number. ' <br /> 1 Bb.Alternate Facility(or Generator) U.S.EPA Ip Number <br /> J <br /> ta+ Facilitys Phone: <br /> wDay Year <br /> 18c.Signature of Alternate Facility for Generator) Month <br /> a <br /> I 19.Hazardous Wa Tanagement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 1 2. <br /> 3 4, <br /> c )A <br /> r 2D.Designated Facility Owner or Operator:Certification of receipt of.hazardous materials cw'vered by the manifest ex t as Wad in Item 18a <br /> PrintedlTyped Nam r Signal re Month Day Year <br /> i <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> .,rc�+.._.J,.rte.,CAtrtl 17'V Tn 9%.11M1LLcrZeTn92 <br />