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1 41 Date/Time FEB-02-2009 (MON) 16. 20 P. 004 <br /> eta 02 2009 4: 29PM H ASERJET FAX • P, 4 <br /> aase print or type nn designed for use on e_Ida(12-pito writer.) Fc OMB No.2050-0039 <br /> UNIFO AZARDOUS LGeneralerb mbar 2.Pagel of 3.Emergenry Response Phone / d.Manlfeat Tracking Number <br /> WA TE MANIFEST 1 ` 1 002037609 JJK <br /> 5.GennrNofs Name and MailingAddress Generator's Site Address(o druerent than maid address) <br /> PM-Acbve Northem Cui twor <br /> 4343 Fast Fremont St. <br /> StOCMM,CA 9.5215 <br /> Genstalor's Phone. <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> EnToko plosirtBl&U tq CAROWMIO <br /> 7,Transposler 2 Company Name U.S.EPA ID Number <br /> AsboxyEtwWwwrteritallSernokyn <br /> 8.Designated Faclliy Name and Site Address U.S.EPA 10 Number <br /> 537755�S.Boyles Avww Corp. CADW7030M <br /> Las Angeles,CA 900% <br /> Favit, s Phone: 371-777-191111 <br /> 9a 9o.U.S.DOT Description(including Proper Shipping Name,Hoard pass,10 Number, 10,co,linam 11.Total 12.UnA 13.Waste Cotles <br /> HM and Packlrrg Grocq(deny)I <br /> No. Type County, WtNol. <br /> t <br /> 0 Non RCRAriam-dous.esb, watd waste ON) G 221 <br /> LNora <br /> i1 <br /> Non RCRAHemrdous west,,NpraW(waste kli4 VO 1� P 331 <br /> a (moi <br /> Nan RCwA HUarooue wast,.w14o(wast,touttmhr soadtlon) DOZ Dm 0 134 <br /> OF <br /> G- <br /> 1A.SpecialHanQnglnslrucromtrod orW In n �� <br /> a.West"04¢� <br /> b.waeda 3h;k ER(W 71 `� <br /> Jim 464c"r <br /> c.waste tadrtdn s water,ops,ktcs a OGt t 1 l4ri (ll <br /> 15. GENERA70R'3IOFFERDR'S CERTIFICATION: I hereby cedant That Ne content oltNs consgnmam ate Uly and acaxalety,described above by Use proper,hoping name,oral ora dassfied,padaged, <br /> marked and labef"plataeded,and an in all respects in proper eand6on or transport according to applicable International and redonsl gmammental regulations.Ilexpo2shipmentandlamrhe Pnrrary <br /> Exporter,I wndy that The conlent of Als wnsignmenl conform to Tho terms of Ne attached EPAAckntr4adgment M Consenl. <br /> I cemy That the Wast mnimiatbn statement identified in 40 CFR 262-27(a)(di am a large quantity gsneelcd or(3)(U 1 am a slreH quantity,generaWq is Irue. <br /> Ger fe Pnned4"Name Sign&Lm MorelDay Yea <br /> Ito/I <br /> '6 Inlemafbnal 5hiWant 'Y 1r <br /> i-it ❑Import be U.S. ❑Ex ❑tom U.S. Pod N entrylexit: <br /> _ Transpaler digraLre(larexportsonly): Dale leaving LLS.; <br /> 17.Tramporter AdmoWedgment of Receipt of Mah la <br /> Transnpdarl pgelav(7yped Name Sgnalure Monty Day eL <br /> i ,17111 tiaoal' QVs <br /> H <br /> 2 TreuPonart Name $kgletare Monts 'Day .Year <br /> o J ��ar fl <br /> 18.Discrapen(41 <br /> 18s.Discrepancy Indication Space ❑ cuanuy ❑Type ❑Residue El Pardo Re)eNan ❑Full Rejection <br /> Manilesl RelerentoeNumbs: <br /> 18b.Altemale Fwtiy(or Generator) II.S.EPA 10 Number <br /> J <br /> U <br /> u Facility's Phone' <br /> w 7 c.SignaNrec'AJI male Fadkty(DIGUnemtcr Month Day Year <br /> Q <br /> z <br /> H19.Hazardous Waste Roper!Managerial Management Method Codes Iia.,codexfor hazardousw st treatment disposal,and mcycling systems) 1 U <br /> 1 \ ' 2 y` 3 LAI a ` ll <br /> 1 20 Desgnatead Facility Crones'0 ler.C00caripn of reaiptt?40u&Mralacread by the mordant except as rioted in item 18a <br /> PnresoRyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rey 3-05) PreviousedifiDnsareobsolete. DESIGNATEDF I TY TOOESTINATIONSTATE (IF REQUIRED) <br />