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`jeh -t C) ll-I n Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 t UNIFORM HAZARDOUS 1.Generator ID Number 1 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number (�(�(� WAS9'E MANIFEST �'f�'r31E1,'54:5'3&8--3 t 1 zat71••�•;,.. g '1".y.( ;_1 �7 f�V 5.Generators Name and Mailing Address Generators Site.Address(a different than mailing address) `J iItbC:r,tr E1;&yy`c: I E,t 12 10 .i Ch r lclkee 1•t? %'0111 CA 95240_ s.,r)c,4 I=mo C70A. :a 4rL Generators Phone: 1 f/ 6.Transports,1 Company Name U.S EPA.ID Number IT IM15 I NC 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address '. `NTai Hr_ 1TH U.S.EPA I"umber -`- s ^ -:364f: TY-•KI_EF-iii OF- CALJIi-ORNIH - _.• .:_ 68891 SMITH AVE:. WOW CA 949f,,O Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total L_ Unit HM and Packing Group(if any)) Vo. Type Quantity ti1't'Vol 13.Waste Codes o ,. ";-RA HAZARDOUS t�t�� TE,11_ID.110, a FNE til YCOL. 800.?T.10N (LESS THAN 50%) U-1 Z LU c� 14.Special Handling Instructions and Additional Information ` H� !_ME.l7E� 1•€L� #1-$fii -ubl�t- ) /f, (SK / 111:1:: ',`-i"'--. 't.Ni i i p`i- Z.. 02 ti, i•• j�, r. 5. GENERATOR'SIOFFEROR'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/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I an the Primary Exporter,I certify that the contents of this consignment corform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generators/Offerors Phnted/Typed Name Signature Month Day Year r J 16.Intemational Shipments a F— ❑Import to U.S. ❑Export from U.S. Port of entrylexit z Transporter signature(for exports only): Da:e leaving U.S.: w 17.TransporterAcknowledgment of Receipt of Materials oTransporter 1 PrintedlTyped Name Signature Month Dal Year Z Transporter 2 PrinteclrN ed Name Q Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type L1 Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. Z 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U rai Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Z z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJ 1 2. G 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdnted/Typed Name Signature Mon:h Days Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY V. _