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8 <br /> Pie ase print or pe,(Form demi nod for use on elite(I2-plt wrlter. • '�/ Form Approved.OMB No.20504039 <br /> 1 UNIFORM HA'(ARDOUS 1.Generator ID Number 2,Page i of 3.Emergency Response Phone 4.Mallifiest Tracking Number <br /> WASTE MANIFEST Cu.1J98(17372125 1 800dA3.9i143 JJK <br /> 5." ra"V!"IdNej m"it,;Not 1t Generators Site Address(if different than mailing address) <br /> Generator's Phone. <br /> 6.TranipQ ! 1 Co pony Name U.S.EPA ID Number <br /> 7.Transporter 2 Cur iroany Name U.S.EPA ID Number <br /> 8.D jMlftd Il"a Address U.S.EPA ID Number <br /> 2000 WORT ALAMEDA 5 i9'2 <br /> TR€€T G.<=1UR8Ct01a <br /> LOh7PTON,G.A 90222 <br /> Faclll 's Phone: d D1%-Ir 7100 <br /> its. gb.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(If any)) No. Type "0uentity WI.NoI. 13.Waste Codes <br /> 1. ',VASTE KAdNI, <br /> 2 FOR RECYU NG/TREATMENT AT THE <br /> 00BROM OM FACIUTY IN <br /> s. CALIFORNIA.THIS FACILITY HAS THE NECESSARY <br /> FERAYTS TO RECEIVE TOUR WISE STRITiAM AS <br /> a. <br /> l 14.41LCI9P.18ErAAMnd Additional Information <br /> 'N <br /> EAR t3LaJES AND EYE PROTECTION. 24 HOUR EMER.cm-m ' GHEATTsl aw.4249300 AND CHICO -DRAIN OI SrTRIMCE <br /> 800.733.9043 <br /> 15. GENERATOR'SIOFFEROR'8 CERTIFICATION: I hereby declare that the contents of this conalgnment are fully and accurately described shwa by the proper shipping name,and are clesslfled,packaged, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport according to applicable International and nagppal governmental regulations.If export shipment and I am the Primary <br /> Exporter,I tartly that the contents of the consignment conform to the terms of the attached EPA Acknowledgmen Consent, <br /> I tardy that the waste minimization state nt Identified In 40 CFR 282.27(8)(If I am a large quantity generator r(b)(If I sm a small quap W, generator)Is We. <br /> Generators/Offerors PdntWyped Name % Signet Month Day Year <br /> J 16.International Shipments r' <br /> Imp nto S. ❑Export from U.S. Port. fentrylexk: <br /> Transporter signature(for exports only): `- Date leaving U.S.: I <br /> 17.Transporter Acknowledgment of Receipt of Materiels <br /> Transporter 1 Pdnted/0yped Name Signature Month Day Year <br /> Transporter 2 RintedItTyporl Name Signature Month Day Year <br /> 18.Discrepancy <br /> 188.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partici Rejection ❑FIN Rejeclbn <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(orGeneretor) - U.S.EPA ID Number <br /> J <br /> U <br /> W< Facility's Phone: <br /> QW fee.Signature ofAPernate Facility(or Generator) Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. Iti 2. 3. 4. <br /> 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 188 <br /> dnted/Typed Name Signature Month Day YM <br /> EPA orm 8700 22(Rei 3-05) Previous edition ere obsolete. `' E IGNATED FACILITY TO GENERATOR <br />