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17699 Form Approved.OMB No.2050-0039 <br /> Chi <br /> n is 4.Maa'n�if{e�sstt TTrracyking Number <br /> n'vironmental & Litho I 003567534 JJK <br /> rent than mailing address) <br /> 2106 Adams Ave., San Leandro, CA 94577•(510) 633-2450• Fax(510) 633-2515 <br /> Customer's Contact 7 Date S U.S.EPA ID Number <br /> Name -7VCJJkA4r , U.S.EPA ID Number <br /> Address Phone "' '' 4 <br /> U.S.EPA ID Number <br /> Manifest Number d <br /> tt Total 12.Unit 13.Waste Codes <br /> Quan. Gal. otal Lbs. Description Price ,e Quantity Wt.NoI.. <br /> Aluminum Plates <br /> Scrap Film <br /> Silver Flake <br /> Silver Recovery Cartridges <br /> Photo Chemical Waste <br /> Waste Ink/Ink Debris <br /> Waste Flammable Liquid <br /> DOT Empty Drums <br /> Documentation Preparation <br /> cove by the proper shipping name,and are classified,packaged, <br /> Emmental regulations.If export shipment and I am the Primary <br /> r generator)is true. <br /> Month Day Year <br /> a <br /> a t Month Day Year <br /> Customer Signature CEL Signa ule Month Day Year <br /> ❑Padlal Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> I i Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone <br /> uu 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> zz <br /> 2 19.Hazardous Waste Report Management Method Codes(i o,codes for hazardous waste treatment,disposal,and recycling systems) <br /> N <br /> 2. 3. 4, <br /> 20.Designated Facility owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> fill PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete, GENERATOR'S INITIAL COPY <br />