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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID i Jumber 2.Page 1 of 3.Emergency Response Phone 4. - Manif6Tc110-65210 u r WASTE MANIFEST C A 1 0 ( 4)U� ()9 4 2 (90 )�Wf�---i 1 9} e U 10 5 610 my I 5.4ener or's Na a en ailing Address Generator's Site Address(if different than mailing address) 1.94 4 N. 1':I flhi Otive Attlr: L4ildli 5dw idt ,fit.21 Btoakside Pond '3$43 'x$:.01 h i { i t3t2}4}tik6t.,x fi�I.tt7 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number r` on;IIall-b us I111vie inwiva,id Svrvlc o 11 lit- 1V1 A t4 i} ''fc ;;>: 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Uwaft Hdi6 s'san Jose 4.1_t;;. 11.021:f�c��sy"t i a Road t_�U)-0 5 6* '�� tsxsts 4VUe,('A AiI23 Facility's Phone: Rai1T3 44;°r 0 'v ga 9b.U.S.DOT Description(including Prop ar Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. 111141%0,WA-11 F.Alw RUP 'tit`-;x..2.:3„1.-1 K.0 QUA ?I'll Y wil 4.}Ott w,. o Y 0 04 1)# 4(31'10 1 Y P Z 2.11NI-1'lit 1xF�l.'�1T4='EtJA V - (NiIf €3 i;t. 1)1'(}#. 00016 Ill s.iJti , Fi, f;1f )DI U M CyAW D4.{'►�81_��.�,�,. € Bb1 11306 00010 P 14.Special Handling Instructions and Additional I formation +• T Ill,t1r t I XTW ill;ro I-1XVRO 1125 J} c .vl w 1,91 -wv,, as 1+T�•*9 fEt .1 3 ff. 15. GENERATORWOFFEROR'S CERTIFICAT ON:;I heretly declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and areclassified,packaged, marked and labeled/placarded,and are in al respects in proper condition for transport according to applicable international and national governmental regulations.H export shipment and I am the Primary Exporter,I certify that the contents of this coi isignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization sitaternei it identified in 40 CFR 262.27(a)(If I am a large quantity generator)or(b)(•d I am a small quantity generator)is true. Generator's/Offeroes Printed/Typed Name Signature Month Day Year jr. rr 16.International Shipments 1- ❑Import l.U.S. ❑Export from U.S. Port of entry/exit Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter kknoWedgment of Receipt of Ma rials Transporter 1 Printed/Typed Name Signature C ..- Month Day Year it 09 to Z Transporter 2 Printed/TypedName Signature Month Day Year H 18.Discrepancy 18a Discrepancy Indication Space ❑ Quantity ❑Typee ❑Residue El Partial Re1'ction ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J V U<- Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Methoi I Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) c 1 F1141 2 111+49 3 14M _7111 }1141 20.Designated Facility Owner or Operator:Certific ation of receipt of hazardous materials covered by the manifest except as noted in ron 18a Printedrryped Name Signature Month Day .Year EPA Form 8700-22(Rev.3-05) Previous editlonE are obsolete. GENERATOR'S INITIAL COPY