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Please print or type.(Form desi nod for use on elite(12-pit writer) Form Approved.OMB No.2050-0039 <br /> } UNIFORM HAZARDOUS 1.Generator ID Number 2.Paplof 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST G•V.Wr37Z4 1 81V-7 1 001941907 JJ K <br /> 5.Generalors Name and Mailing Address Generelor's She Address(if different than mailing address) <br /> STOCV706i SCAVFNIPEF." AYM.) <br /> 1240INA.+dr Ri;rE <br /> `"rOCH?ON Cook $5205 <br /> Generators Phone: 2CM3-450 301;:1 <br /> 6 Transporter 1 Car ipany Name U.S.EPA ID Number <br /> .:I UC C'DF:4 Rh On- : `: _` <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desi nated Facultyry Name and Site Address U.S.EPA ID Number <br /> SIEMENS VJER TECHNOLOGIES CORP <br /> 5376 SOUTH BOY LE AVENUE: CADOg70S09Ah1 <br /> \MRNOK CA 900BB <br /> Faclll 's Phone: W-277.4800 <br /> 9a 9b.U.S.DOT Description(Inclu ling Proper Shipping Name,Hazard Class,ID Number, 10.Contalrrem 1i.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(If any)) Np, TYPe Quantity WI.Nd. <br /> 1. NON RCR.A HAZARDOUS'vVA&TE SOUD / DM _,{_ P 423 <br /> !� <br /> 2. <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Addltlone Information <br /> SERVICEBSORBENT.SfSOUDS .. . .,.. __ _. _ .. _ .. ..... rs. . .. <br /> WEAR QI-OVEYE ES AND PP,OTECTION. IN CASE OF EMERGENCY CONTACT CHEMTREC AT Bop-424.93017 AND CHICO DRAIN OIL. <br /> AT WO-733-9043 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this conelgnment are fully and accurately descabed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are In all roe"In proper condition for transport according to applicable Intematlonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the tonne of the attached EPA Acknowledgment Consent. <br /> I certify that the waste minimization statement IdemM In 40 CFR 26227(a)if I am a large quantity gsneraWr (b) If I am a small quantity generator)Is true. <br /> Generator'sr rs Pm Name ,A 71 Sig netu Month ay Year <br /> U� 0- /O 10 : <br /> 16.International Shipmentat, El <br /> Import to U,S. ❑Export from U.S. P ofenhylexN: 41 <br /> Transports signature(far"ports only): Date leaving U.S.: - <br /> K 17.TrensporterAcknowledgment of Recelpt of e 7 <br /> Transporter 1 PrintedRyped NemeIgnature i ' Monts Day Year <br /> Transporter 2 Pdntedflyped Name Signature Month Day Year <br /> t18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Part Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Q <br /> U <br /> sax. Facility's Phone: <br /> F18c.Signature of Alternate Facitity(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(I e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. v 2. <br /> 1 20,Designated Facility Owner or pe oc Cemtcation of f Nous materials covered by Ne manifest except as rated In Item Vil <br /> Pan yped area 7 nature Month Day ear <br /> y... <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DE GNATED FACILITY TO GENERATOR <br />