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California 7439 <br /> Environmental & Litho <br /> 2106 Adams Ave., San Leandro, CA 94577•(510)633-2450• Fax (510) 633-2515 <br /> Customer's Cont c Date O /7 <br /> Name I t,4 �J <br /> Address Phone <br /> Manifest Number <br /> Duan. Gal. otal Lbs. Description <br /> Price <br /> Aluminum Plates <br /> Scrap Film <br /> Silver Flake <br /> Silver Recovery Cartridges <br /> Photo Chemical Waste <br /> Waste Ink/I k Debris <br /> Waste Flammable Liquid <br /> DOT Empty Drums <br /> Documentation Preparation <br /> ✓c-vt/ / <br /> Z �L <br /> Custo rr signature CEL Signature <br /> Mannestnnro, <br /> 18b.Alternate Facility(or Generator) <br /> J <br /> Facility's Phone: <br /> w 180.Signature of Alternate Facility(or Generator) <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systei <br /> G 1. 2. 3. <br /> 20.Designated Facility Owner or Operator:Cenification of receipt of hazardous materials covered by the manifest except as noted <br /> Pnntedrryped Name Signature <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br />