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Please print or type.(Form designed for use on elite(12-pitch)tyv�writer.) Form Approved.OMB No.2050-0039 <br /> T UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3 Emergency Response PhoneManifest Trackingr�Number <br /> WASTE MANIFEST CJIf�11AtI1 ApA��] _T00403) 605 <br /> . 0 0 4 5?3 6 0 5 JJ K <br /> Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Shea CA Plnducls LR5 2375 W.Gmtt Line Rosy <br /> 12700 Norl tbix",Drhv Tregr,GI 65378 lRSll <br /> Hofs�II-rX 77097 <br /> Generators Phone: 1W5. 0 7 A.'Ww, <br /> 6.Transporter 1 Company me-' U.S.EPA ID Number <br /> IA"w1Cafl lnc_: -- CAMMI -. .-. - - -- . <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Yaj4[S TaCtw"SdAAW rs CAD008axm <br /> I WM West RTA 11Rr" <br /> AZLIM CA 91702 <br /> Facility's Phone: 026 3aAl 117 <br /> ga. 9b.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 Quantity Wt.Nol. 13.Waste Codes <br /> 1. <br /> o 11113175 WaIIHASa tfiGurttalnhp Fiatxnibws <br /> laLkW,r ,4,1,M IFI DM P 352 DWI 0018 <br /> cConl.+n��18� I 40 <br /> w <br /> Z 2. <br /> LU <br /> r ,. <br /> 3. DIM <br /> NOV o 4 2008 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Wwr aRpralprlala YVuW fz or Ydun 6 are avprardmatw <br /> Atnarttenh Val <br /> J111:11blill 6 v�3 136187 Pft a2,F5_q <br /> 15. GENERATOR'S/OF�EROR'S CERTIFICATION hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled placarded,and are in allyspects in proper condition for transport according to applicable international and n7t, nal governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify at the contents of this signment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the ste minimization sta ement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a s puantity generator)is true. <br /> Generator's/Offeror's P' tedlTyped Name Signature / Month Day Year <br /> .r 16.International Shipments / \/ <br /> z <br /> 1:1 Import to U.S. ❑Export from U.S. Port of entry/exit <br /> Transporter signature(for exports only): Date leaving U.$ <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Tra;sTransPorterr 1 Prpted/Typed Name Signal eMonth Day Year <br /> CL XWLyr,� <br /> QTransporter Printed/Typed Name f Signature Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity El Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> v <br /> Facility's Phone: <br /> C3 18c.Signature of Alternate Facility(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 /> 2. 3. 4. <br /> 20.Designated_Eacility_Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a -' <br /> i <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(F3ev:3=05) P?evious editions are obsolete. l ---`- DESIGNATED FACILITY TO GENERATOR <br />