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Please print or type.(Form designed for use on elite(12-pitch` gwriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phor. 4.Manffest Tracking Number WASTE MANIFEST JJ K 5,Generator's Name and Mailing Address Generators Site Address(if different than mailing address) MW6"BuHehn 276 Btdton Avenue Manteca,CA 95336 Generato 340 26M s Phone: 6.Transporter 1 Company ame U.S.EPA ID Number Calitomia Environmental 8 Lift CAR 10 7 Transporter 2 Company NameO U S.EPA ID Number 8.Designated Facility Name and Site Address U.S EPA ID Number Siemens Water Ta motogies Corp. CAD007030M 5375 S.Boyles AMYX* Los Angeles,CA 90058 Facilitys Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12.Unit 13.Waste Codes HM and Packing Group(i1 any)) No. Type Quantity Wt./Vol. 1. Non RCRA Hazardous Waste,SoNd(Waste I nic con*. ninsted detxis) CF P 0 ov /Dv 1e z 2. W 3. 4. 14.Special Handling instructions and Additional Information a.Waste deals,Plastic txilcksts,corltalmiinatei with ir* #=30J�03 ERG*1711 1317 3 / 15. GENERATOR'S/OFFEROR'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, marked and labeled/p(acarded,and are in all respects in proper condition for transport according to applicable international and na'onal governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR262.27(a)(if I am a large quantity generator)or(b)(f I am a s all quantity generator)is e. Genera;grleroes Printe d Month Day Year e Signa e M 3 `, 16.linfWational ShipmentsCJI V F ❑Import to U.S. ❑Export from U.S. Por;of entry/exit: z Transporter signature(for exports only): _ Date leaving U.S.: 17.TransporterAcknowiedgment of Receipt of Materials Trans er nted7T Name Signature Month Day Year kw)A�L� lo 3 12V 0q Signature Month Day Year Z Transporter �nted[TypedName Vo Q 0 4,j li, L'AA pI �q 1 B.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. F. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facllitys Phone: Month Day Year w 18c.Signature of Altemate Facility(or Generator) Q11 z v5 19.Hazardous Waste Report Management Method Codes(i.e.,oodes for hazardous waste treatment,disposal,and recycling systems) LLI 1, � 2. 3. 4. 20.Designated adlity Owner rator.Certicaton of receipt of rdcus Tateri by the manifest except as noted in Ite Prnted/TypedName Signature Month Day Year 4 's 4J2 1EPA Form 8700-22(Rev.3-05) revious editions are obsole e. DESIGNATED II Me TO DES !NATION STATE IF REQUIR D)