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Please print or We.(Form designed Idi&Vim on l2-pitch)lyp6dler) Fo L"""OVad.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS I 1:13endalor ID Number 2.Pagel'of 3.Emergency Phone Manifest Tracking Nlrilb—ll n <br /> 3 0 jillf <br /> 103C M. 17 41 <br /> WASTE MANIFEST i�kijf) T ul J a if K <br /> 5.Generators Name and MalthigAddress Genemlo?s Silefirldress(if igiferenithan inaffing address) <br /> F OLf-1-l-%zjFST <br /> IC .3 <br /> 8372 S.JACKT01%)R0. <br /> CA 952-15 <br /> Gemeralons Phone. <br /> B.Transporbirl Company Name U.S.EPAIDNumber <br /> George w Lowry,Inc.. <br /> blvtL) <br /> Transpode ratio <br /> U.S.EPA ID Number <br /> APR 08"7015 1 Cd,!-q�d6w?zffQ, <br /> '3 <br /> a. ile 11,ess <br /> L ft U.S.EPAIDNomber <br /> '�a <br /> 1600 1-%LQjIED1k St. <br /> rr"NiPTOPI,C;% jjjQ222 EWRONMENTAL <br /> lFacullYsPhone: 810-507-`,01- <br /> as. go.U.S.DOTDascription(including Proper Shipping Name,Heard Class,10 Number. L Coal 11.Total 12,Unit 13.Wale Codes <br /> Ind and Packing Group(titany)) No. isis Type Quantity WINOL <br /> U111 190 klVASTE FLAAXAAEUy Ll,—IljlD fqijscjjne alesel rai.,q 3 Poll <br /> Mi <br /> nrchlnil] I IFIED <br /> z 2. �LKr <br /> -mlvi I <br /> Ilk,GFIR-EAT MONTS A <br /> FOR RECYCLi! T TIAF <br /> . ....... <br /> ti. ... <br /> CALIFOR11 <br /> IR (r I ..�h <br /> pERlii-10 REG 13352 <br /> 4. A <br /> )UALIFIED.UUK <br /> 14.Special Handling Instructions andAdditiond!Information. <br /> -q�'scuw qlFs.-L N"Iff USE QSF,4 3p00oyarf sarety prEp7jullon,; <br /> 5. GENERATOR'SIOFFEROR'S CERTIFICATION: I herebydeclare that the contents of this consignment are fully and accurately described above bythe propershipphil name,end are classified,packaged, <br /> marked and labelecirplacarded,and are in all respects in praparconinj ion fortranspod according to applicable Inlemallonaland national governmental regulations.Ifexportshipment and I am the Primary <br /> Exporter.I certify atthe contents of consignment Willienno to the lens of the attached EPAAcknoviledgmentafConseal. <br /> I cergly that thems1a minimization statement Identified In 40 CFR 262.27(a)(If I am a large quarfilygeneralor)or(b)(ff]am a small quanblygenemlor)Is We. <br /> GeneraloeslOfferm's Printedflyped Name Signature Month Day Year <br /> r—r16.International Shipments <br /> El Import I.U.S. D Elimat from U.S, Ped.fariliftit; <br /> Transpodersignaltue(foreXpEmS only): Date leaving U.S.: <br /> 17.TransporierAckfloaledgment of Receipt o[MaledaFs <br /> Signature/ <br /> imoor 13�—Y- 1 ML <br /> Transporter 2 PA_nteffyped Name, <br /> r Signature Month Day Year <br /> 12 <br /> 4. 18.Discrepancy <br /> life.Discrepancy Indication Spam v <br /> 1:1 Quantity 0TYpa El Residue ElParthil Rejection El Fail Roiaction <br /> Manifest Reference Number. <br /> 18b.Alternate Facifly(orGenerefor) <br /> U.S.EPA ID Number <br /> LL FacRiVs Phone: <br /> 18c.Signature ofAllematel'aciWity(or Generator). <br /> Month Day Year <br /> 19.Iftusirdous Waste Report Management Method Codes(i odes forhazardous waste Vestment,disposal and recycling systems) <br /> r 2. 3. 4, <br /> 20.Designated Facculy Onneror Operator.Certification Direceiplothazardous materials covered by the manifest except as noted in Item 18a <br /> PrinledlTyped Name Signature <br /> Month Day Year <br /> EPA Form 8700-22(R&3-05) Pretilibre—dilions are obsolete. `DtSfGNAT ED FACILITYTOGEffER-97—MIR <br />