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Pleas.q printor type.(Form designed for use on elfte(12-pitch)typewriter.) _ - • Form Approved.OMB No.2050-0039 ? UNIFORM HAZARDOUS 1 Generator ID Number 2.vae 1 or 3.Emergency —ReFsponse Phone 4.Manifest Tracking Number WASTE MANIFEST Of O '�g �ZOQ� ' P J07,4 QII .�r r� ,�' JJK 5.Generetors Name and Mailing Address Generators Site Address(if different Nan mailing address) CS 1�t'�IIV InC� �ZC - I 2-222 S. 9 t V CLAtP. .E. rsTOCIGTQN CA ieratoes Phone: Qgl / — tjDoc --Transporter 1 Company Name U.S.EPA ID Number /Z L) Sf �P SDN s O.A l $�gZZ 7.Transporter 2 Company Name U.S.EPA ID Number S. ig ted FacilityCOI,and Site Address fa1�v ftA gE U.S.EPA ID Number W� �� Ol 11 `l VV IVEV�-D,4 �90o� I II �Ult� ys/�,16F f�E-�Y, Facild es Phone: D 0 • 239 • -2 I`F� I N ✓t 33 bo j p o()0 9a, 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)) 13.Waste Codes No. Type Quantity. WLNoI. 0 X ,.� .0 g ui Kc�t wti a E.4 a q � � O 1f� G� 1�7�,1 I� � w 2 I 4. i 44.Special Handling Instmctio s and dei rel Information i�tX D 1 T II 15. GENERATOR'SIOFFEROR'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 Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,t cert'dy that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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)(f I am a small quantity generator)is true. Generators/Oferors Pdntedrryped Name Signature Month Day Year 16.International Shipments ❑ Import to U.S. ❑Export from U.S. Part of entrylexit Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transported Pdnted/Typed Name Signature - O Month Day Year a N Z Transporter 2 Pdntedliyped Name Signature a 9 Monty Day Year K F- 4. 18.Discrepancy Vv �^�- 18a.Discrepancy Indication Space El Quantity y iBue ❑Parfal Rejection ❑Full Rejection Manifest Reference Number. r 181b.Altemate Facility(or Generator) t• 20U.S.EPA ID Number U LL Facility's Phone: NARE'4YTAL F F d-TH W 18c.SignaNre ofAltemate Facility or Generator) , � Month Day Year a z cr0—, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. i 1- Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item like omewIyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. - GENERATOR'S INITIAL COPY