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or type (Fon deslgned for use on elite (12 -pitch) typewriter.) <br />Form Approved. OMB No. 205HO39 <br />EPA Form 8700-22(Rev,3 )-lareviousellitionsareobsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS 1. Genemlw ID Nunber <br />C A L 0 0 0 3 7 7 8 7 5 <br />2, Page 1 of <br />1 <br />3. Emergency Response Phone <br />800424.9300 <br />4. Merril Trading Number <br />1 017179821 JJK <br />WASTE MANIFEST <br />Genemafs Site Address (i/ different than mailing address) <br />s. c,AXy 0 Uf a am fncisco City and County of Sen Francisco FUdk lM V Commission <br />1390 Market St STE 219 9000 W. WfnaRS Rd <br />San Francisco CA 94102 Tracy CA 95377 <br />Genemlors Phoma: 4-1_5 7 0 1. 5 6 8 4 <br />6. Tasporter 7 Company Name U.S. EPA ID Number <br />EnvirontneMaILogistics, I CAR 0 0 0 2 1 7 5 1 3 <br />7 Transport. 2 Company Name U. S. EPA IO Number <br />S. Designaledfaotity Name and Site Andress U.S. EPA ID Number <br />Hak- rfft inc. <br />6300 Stadium Or <br />Kansas City MO 64129 <br />Faatilys Phone: 816 924.5884 M O D 9 8 1 1 2 3 3 9 1 <br />qa <br />96. U.S. DOT Descriptor (including Proper Shipping Name, Hazard Class, ID Number. <br />10. Conainws <br />II. Teal <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Pecking Group (it any)) <br />Quantity <br />NRNd. <br />X <br />1UN1791, WASTE FlypoctW(ta soludorts, 8, PGII <br />WIN <br />123 <br />9Z— <br />x <br />Iry <br />W <br />W <br />CD <br />X <br />21Ar11710, WASTE FNruosRkk acid, 8, FIGH <br />D002 <br />791 <br />�� <br />3.NA4 0-77y ;4,4-z+jZD6k,5 tU/b Z sou oy .v o S <br />91181 <br />x <br />9 Il Dz to s) <br />I <br />'Dh4 <br />! o o <br />4'UN 32GYI JVAS-rt Col(A.CSIVE LL4LI td5) f%C.t 0 ( C <br />610 akvtiC-/4c-LID <br />pp <br />1 Spatial Hereford Instructions and mNmw I77o.0 Z 7DTiS1 AA �&A4"7 0"94 5 �/ X'�) too t'� 30 (p 9 �+ / � <br />p4tocf+bru.'rE K <br />y) FP—L. C12457 <br />i)tGw7r.o51LICIC.4GaDSotrt.✓(3><mrfs� <br />C4�f +rnec CGk�G6823Z <br />15. GENERATOR'SlOFFEROR'S CERTIRCATION: 1 hereby declare that the amana of this consignment are Ally and accurately descried spew by the proper shipping name, and are classified, packaged, <br />marked and atielediplaauded, and are in all respects in proper andaen for panspwt according to applicable mtematianal and natoal govemmental regulations. If export sNpmem and I am Me Primary <br />Exporter, I certify that the contents of His consignment conform, to the home of dm attached EPAAdmirmledgment of Consent <br />Icwbh'their the wasa{mrvmbation statement identified in 40 CFR 2VX(a) it l am a large quantity garzmta) or (ill aura Ilquamdy nemmr)isbw. <br />Genemlahi0lfemB iradT Signature Monty Clay Year <br />!a 7 i7 <br />J <br />p_ <br />16. Intemalicnal Shgmena <br />+.,�. ❑reporla US. ❑Erparthom U.S. Portatemryletlt <br />Transpwlersgnahue (for exports Doty): Data INY44 U.S.: <br />K <br />17. TmnsfaoderAGmowedgment of Receipt of Materials <br />Signa Month Day Year <br />TTnnkaader I PdntedlTyped Name <br />$ <br />za&/a 17 1/7 <br />QTmnsmw <br />2 Pimrffyped Name S' are Month Day Year <br />t9. Discrepancy <br />I <br />16th. Discrepancy Irdatian Space ElQuantry []Type❑Residue ❑ Partal Rejection ❑Full Rejection <br />Manifest Reference Number <br />t8b. Alamate Fadity (or Generator) U.S. FPA IO Number <br />J <br />U <br />Fialitys Phone: <br />w <br />191— Sigatae of Alternate Facility(or Generator) <br />Month Day Year <br />Q <br />2 <br />N19. <br />Hazardous Waste Report Management Method Codes Cie.. codes for hazardous waste treatment deposal, and recorg systems) <br />O <br />1 <br />2. <br />Facility Owner or Opemtrr Cerlifiawn of receipt of hazardous maarials covered by the manifest except as noted in Item IBe <br />�nameSignature Month Day Year <br />EPA Form 8700-22(Rev,3 )-lareviousellitionsareobsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />