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writer. Form Approved.OMB No.2050-0039 <br /> Please pont or type.(Form designed for use on elite <br /> (12-pitch)typewriter.) 2.page t of 3.5sragerwy Response Phone 4.Manilesl Tracking Number <br /> UNIFORM HAZARDOUS 1. <br /> Generator Numbo 1 800-255-3924 016098682 JJK <br /> WASTE MANIFEST CACIX12895237 <br /> 3 / am ndh li Adtlress eneralofs Site Address(d dglerent than mento address <br /> C.�p���,s NSg��a7, ON lP1IGHT TRANSPORTATION,215595.SIN LAIR AVE,S70CKTON,CA. <br /> 20002 NORTH 19TH AVE 05027 <br /> PHOENIX <br /> 602 269-2000 AZ <br /> Geinrerata'stePr�loreo'mU.S.EPA ID NumCer <br /> ENy1ka6�y�MATAL SERVICES CAD053866794 <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> yt%5ajV,,aMjR910Nnd SaeAddrees CAD028409019 <br /> 1630 WEST 17 TH STREET CA 90819 <br /> LONG BEACH <br /> 800-827-6729 <br /> Faci6N's Phena: <br /> mg op PP,g No CoNair�a it.Qu Total 11 Una 17.Waste Codes <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,hlazard CIau.ID Number, No. Type Quantity WtfvoL <br /> HM and Pal Group(Nang)) _ 352 r <br /> 1. womwROMTKINIOTE RUE; DEBRLS <br /> Od w <br /> DM O'1� (� P <br /> O <br /> Z 2. <br /> w <br /> c'J <br /> 3. <br /> 4. _ <br /> 14.S al llandli Instructions amAddifwnal!nim r Ion EQUIPMENT 3061f/FOIE:08-17-00079 PROFILE/f: �' 5 JY <br /> WEAR APPROPRIATE PERSONAL PROTECTNE EQPREMENTIUM ENVIRONMENTAL 17-071-01128 <br /> 100523 Q 4 I 11 -L- <br /> 15. <br /> l � <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereybdeclare mal Ne conWnls of this cons.........am rally end accurately described aboaa by Na proper shipping nard-me,laarta damped.ppaclmgedk <br /> marked and Wbeledlplaearded,and are in all respects In prope,condition for transport according to applicable InlerrelWnal and national governmental regulations.II export shipment ead I am the Primary <br /> Exporter I cAfy that Ow contents of Nis c,r,gnmem conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste narxniza ars statement Menfified in 40 CFR )(if I am a lar a vanity genet m a s an gly generator)N We. Man- Day Year <br /> .G relofenforce Pr Iedtlyped Names � s ! Y�,w 4 " �yf}�I, !J.'r <br /> {' 31 r Vim. ii I <br /> —z 16.Intematiowl Shipments �Impod-U.S. ❑Expel Gom LLS. PoM1of enlrylevd: <br /> i— Date leaving U.S <br /> Transporter signature(for exports only): <br /> oc 11.TranspoftAdvmwledgment of facelptofMaterials , Manlh Day Year <br /> Transporter 1 Pdnted?yped Name - Sk7ralum <br /> u5 6aYGlu o Mon- Day 3l <br /> rL Yea, <br /> Transporter 2 Prmle irryped Name Signature <br /> K <br /> r— <br /> } 18.Disoepanry <br /> FuP Rejection18a.04screpanq Indication Space 0uyrliry ❑Type ❑Residue ❑PaNal RejecCan <br /> Manifest Reference Number: <br /> U.S.EPAIO Number <br /> 18b.A8emale Fidlily(orGenamlor) <br /> U <br /> u Facgflys Phone: Month Day Year <br /> w 18C.Signature class...a Family(or GBnarall <br /> 6 <br /> Z d al,and recycling systems) <br /> 19.Hazardous Waste Report Management Method Codes(Le,codes for hazardous weals treatment !spas Yc 9 <br /> C 1. 2. 3 4. <br /> 20.Designated Fzdlily Owner or Opemtar.Certi6cztian of receiptof hazardous maledeis covered by-e manifest except as Med In Item 1 Month Day Year <br /> gnalare <br /> PdntadRyped Name <br /> EPA Form 8700.22(Rev.3-O6) Previous editions are o6Solete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />