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---- <br /> Al <br /> d– ;, « <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST t�r�)��i��i E L 925 540-•79113 , - 8 8 J J K <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> 1?,ACX1;'ZC WEST ff�2Ct�� <br /> 550 W. VALP T;~0 R-fj U) r`1faoo ':t.'f�k`ar,-� 'i,t f"a <br /> Generator's Phone: 915 S44-7'910 &kI-Xi itwjr32krl 3k:OVA3:1«F.0 TV-UCk SIA 95-ij/4a <br /> 6.Transporter 1'Company Name " U.S.EPA ID Number <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site AddressAA;+66yyrtrtI� gx pFy �yDIXON - U.S.EPA ID Number <br /> 2000 —R- T'SJltAME3 A STREET' 7 i '70x <br /> Facility's Phone, 7110 5 3°;-F1 O0 f-DWIXIS, CA 913222 <br /> 9a.• 9b:U.'Si IJ6Tbescription(Induding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> eiid Paciclhg Group(if any)) 13.Waste Codes <br /> HM i No. Type Quantity Wtivol. <br /> ; '€1G �f €3Lft+°°.4 eyi' atji Saittf8i1 L i' <br /> LU <br /> Z 2.CD <br /> r!r ) <br /> w <br /> 3. <br /> i <br /> i <br /> 4. I I <br /> r <br /> 14:'Sp,'e.)a,Handli00,InSNrctions an,d'Addltibnatliiforri atlon <br /> COMMTOR: MAW SONS €'.t;957'.f..lC4'TIW, :tRC ifs£r..t? Wail <br /> I <br /> i <br /> 15. GENERATOR'SIOFFEROR S CERTIFICATION: I hereby declare that the contents ofthis consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, j <br /> marked and labeledlplacarded;and-are in all respects in proper condition-for transport according to applicable intemalional and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter I certify the contents of this consignment conform to-the terns ofthe attached EPAAcknowledgment of Consent. <br /> tcertfy that the waste minimization statement identified in 40 CFR 262.27(a)(if I am large quantity generator)or:(b)(ifI am a small quantity generator)is true. <br /> Generator's/Offerors Pdnledrryped Name Signature Month Day Year <br /> A Ihtetnallonal Shipments <br /> P- ❑lmpod to U.S. ❑Export from U.S. Port of entrylexit: <br /> Z Transportersignature(for exports only): Date leaving U.S.: <br /> w' 17.TransporterAcknowledgment of Receipt of Materials <br /> 12 Transporter 1 Printed/Typed Name Si natur - <br /> }}.. 9 f t �T Month Day Year <br /> LZ <br /> za Transporter Printed typed Name Signatu " Month Day Year i <br /> � r <br /> 18.Discrepancy <br /> Ise.Discrepancy Indication Space Quantity ❑Type <br /> ❑Residue ❑Parital Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number I <br /> U <br /> w Facility's Phone: <br /> F18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> CD 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 Faality Owner or Operator:Certification of receipt of haiardous materials covered by the manifest except as noted in Item 18a <br /> P.,rintedlTyped Namel r Signa!urg, Month Day Year <br /> t ,i-. /i'1.A�2��'"z '2,1 X s%'`t -�✓%� C. 1 <br /> EPA Form 8700-22(Rev,3-05) Previous editions are obsolete. 7 I'liRANSPORTER'S COPY <br /> ra rx,z rsa <br />