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easaffirrint or type (Form designed for use on elite(12-pitch)typewriter.) conn Approved.OMB No.2050-0.039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number WASTE MANIFEST oD�C A L 0 0 0 2 8 0 7 6 a , a4MM JJK 5.Generatol 4 me and Mailing Address Gmrembr's Site Address(if different than mailing address) -- 9-1 yFuel$27O7 Fkaase 94511101 Sbdlbn CA 96,207 Generator's Phone: Sri: 5 7 3 _. 'r - mnsportar 1 Company come U.S.EPA ID Number Envtdmrorfal Loghlbs, Im. C A R 0 0 0 2 1 7 5 1 3 7.Transporter 2 Comperry Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.FPA IO Number fi 1m1n1 hie. 6.900 SbdWm Of Krrus CI!f MO 64129 Facility's Phone: ill 92A.Siii IM 0 Q 9 8 1 1 2 3 3 9 1 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Haaerd Class,ID Number, 10.Corlett 11.Total 12.Unit HM and Packing Group Of any)) No. Type Qua" WLNoI. 13.Waste Codes 1UN1993,YIMSTEFbmitrf,N .aoz.,t9oso11kyo1,3.PG0 r x R0Ot N]1fi. 343 w t7 i ,i l;, special,Handn �nswdlon8 a[i henel�n ., u W17 15. GENERATOWSIOFFEROR'S CERTIFCATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are tlessill packaged, marked and labeletiVacarded,and ere M all respects in proper condition for transport according tu applicable intemsfi ladd national governmental reguiagons.If export shipment anti I am the Primary Exporter,I carty that the contents of this consignment conloml to the terms of the attached EPA Acknowledgment of Consent I certify that dw vaste minimization statement Identified h 40 CFR 26227(s)(if I am a large quantity generator)or(b)(til am a small quantity generator)is we. Generalor'sfORe a Pint!'5 Namp SigrheWre Year -a) J 'W 1 (� r 71 G�— 1 .Inlamaaonal Shipmeraa;~^ I r ❑Import tc U.S. ❑i a.U.S. Pad of erNylexlt Transporter sgnature(for exports only): Data leaving U.S.: w .TransporterAcknomledgmemof Rac lofMaterials O T rte rim �Neme Si » fd�h Da Year der T nsporter2 cin ypetl ams Signature Month Day Year 18.Discrepancy 18e.Discrepancy Indication Space ❑ Ouantiry ❑Typo ❑Residue ❑Partite Rejeaion Dull Rejection 3 Manifest Reference Number. 18b.Allemete Fadtity(or Generator) U.S.EPA ID Number V l FacHitys Phone: w 180.Signatureof Ahermate,Facility or Generator Month Oay Year Q 2 w19.Hazardous Waste Report Management Method Codes Q.e.,codes for hazardous waste treatment,disposes,and recycling systems) coo ,. 2. 3. 4. 441 1 20,Designated Facility 2=or Openamr.CeNticabon of of hazardous materials covered by the nar til l except pAsill lienttea Fronsorrypeo Mme '1 51gpaNre �/ � 4 EPA Form 8700.22{Rev.3.05) Prevl0us onsaraobsolete. DESIGNATED FACILITY TO GENERATOR