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V'PleasJprint or.�,e.(Form designed for use on el to(12-pitch)typewriter.) Form Approved.OMB No. <br /> Ux`,�OF 1�GI HAZARDOUS 1.Generator ID N mber 2.Page 1 of 3-Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST >t 0044!5 f11:1Ed`s 1-8-4`0 4'?A 'r 001652392 JJK <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> SANBORN 0*VR1)1 t-.). <br /> 12t `a. t:HEROK E-E: LA+ <br /> Generators Phone: =%� '.s34 E9 <br /> 6.Transporter 1 Company Name_ U.S.EPA ID Number <br /> t.:40 •q <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 1 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 3tf,ie`r EAST PTCO "BLVE3 <br /> LOS ANGELES, CA 900'..' <br /> Facility's Phone: l 8 f 49~ 714FS <br /> ga 9b.U.S.DOT Description(including Proper hipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> JI #'siX 1. t`rJn (t7(erti1. 1 <br /> d <br /> i rias <br /> Z 2. <br /> ! W <br /> C7 <br /> 3. <br /> i 4. <br /> t <br /> 14.Special Handling Instructions and Additional Info ation <br /> '1h t l ,APP ani S 9 <br /> i3LfJ�JF±, <br /> G066 S F'4ir rr,r T T.VV 0THT Ws , <br /> f?rR�•� ntkl ) �QTS <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATIONI 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 labeled/placarded,and are in all res acts in proper condition for transport according to applicable intemabonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consig ment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement id ntified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generatoes/Offeroes Printedffyped Name Signature Month Day Year <br /> -j 16.International Shipments <br /> { ❑Import to U ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17,Transporter Acknowledgment of Receipt of Material <br /> TranspgderT'Pdnted(ryped Name Signature Month Day Year <br /> no <br /> QTransporter 2 Printed/Typed Name Signature Month Day Year <br /> f ~ <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ QuanEl Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> ( J_ <br /> V ' <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> S2 19.Hazardous eporanageme <br /> dous Waste Rt Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G LLJ 1. 2. 3. 4. <br /> i <br /> j <br /> E- <br /> EPA <br /> ated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> ed Name Signature Month Day Year <br /> Form 8700-22(Rev.3-05) Previous editions are 7buiele. GENERATOR'S INITIAL COPY <br />