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i <br /> Form Approved.OMB No.2050.0039 <br /> ":Please prsnf or type.(Form designed for use on elite(32 pitch}typewriter.) 2 page 1 of 3.Emergency Response Phone 4�AanlfesrTrac_ng Number <br /> 1.Generator ID Number rr�� <br /> UNIFORM HAZARDOUS 1 310 675_2500 0 0 4 2 0 2 5 8 3 JJK <br /> } WASTE MANIFEST CAL000286804 1 <br /> Generator's Site Address(irdifferent than mailing address) <br /> 5.Generator's Name and Mailing Address i <br /> I: CF J PROPERTZES <br /> 333 WEST CENTER ST34EET FLY33IG J TRAVEL PLANA <br /> NO. SALT LAKE, UT 8+3054 1501 N. JAM TONE ROAD <br /> Generator's Phone: 801 296-3700 Attn: 833?UH CA 9'538!6 <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> ADAMS SUMCES, INC. <br /> U.S.EPA I9 Number <br /> 7.Transporter 2 Company Name <br /> B.Designated Facility Name and Site Address U.S.EPA S4 Number ' <br /> MEMDOM <br /> 2000 ff.. ALANWA STRW lCAT000013352 � <br /> OWTM, CA 90222 <br /> Facility's Phone: 310 537-7100 <br /> 9b.U.S.DOT Description(Inducting Proper Shippfng Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> 9a. Na Type <br /> Quantity Wt.Nol. <br /> HM and Packing Group(if any)) <br /> "NM—RCRA HkZMOUS biAM 6I=13 <br /> (OIL a tefll LIR) 1 TT 50 <br /> G <br /> a 2+l1 <br /> !r <br /> z 2. I <br /> rU p_ F <br /> 1 <br /> 14.Special Handling Instructions and Additional Information 1)99% IMR, 1% OYZ <br /> AVOID EYE CONTACT s WAR RUBBER CLOVES <br /> CONTRACTOR: CHARLES B. T}i0W CO_, INC- ; <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemationai and national govemmentai regulations.If export shipment and I am the Primary <br /> Ex orter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> certi that the waste minimization statement identified in 40 CFR 262.27(a)(if!am a large quantity generator)or(b)(if I am a smail quantity generator)is true. <br /> e eralor's10 erors Priniedf`ryped a �ru'eliro_w <br /> Month Day Year <br /> {�� c1 Q <br /> [17. <br /> 6.Internationaf Shipme ❑Export from U.S. Port of entrylexit. <br /> F Import to U.S. <br /> ransporter signature(for exports only): Date leaving U.S.: i <br /> Transporter AcknovAedgment of Receipt of Materials Month Day Year <br /> Transporter 1 PrintedlTyped Name Signator <br /> . Z o <br /> CL '4L CA S 7 F—(.4 O./ <br /> Month Da Year <br /> ZZ Transporter 2 Printed/Typed Name - r Signature y <br /> I <br /> 1 <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection j <br /> i <br /> Manifest Reference Number: <br /> 18b.Allemate Facility(or Generator) U.S.EPA 1D Number <br /> C? I <br /> LL Faciky's Phone: <br /> LD 1Bc.Signature otAlternate Facility(or Generator) Month Day Year <br /> I <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> A 1 2. 3. 4 <br /> I <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1Ba. <br /> Printedrryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. UUUUJLDESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />