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56 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> UNIFORM HAZARDOUS Generator ID Number 2 P Fm EP ed.OMB No.205MO39 <br /> Manifest4. TrackingNu Approved. <br /> WASI E MANIFE it <br /> I' - <br /> 3.Generators Name arid Mailing iGTmu— 005947113 SKS <br /> Generators site Address(if different than mailing <br /> All CA <br /> 6 TrartsPorler I Company Name <br /> 1, U.S.EPA ID Number <br /> 7 Transporter 2 Company Name <br /> U.S.EPA ID Number� <br /> 8 Designated Faclity Namis,and Site—or,n <br /> :;1,41-1-rl� ;r! f..1-.NIV US EPA ID Number <br /> F,&C16 <br /> Facility's Phone: f P-1 f.T'.1 t,,'t:f P <br /> 9a g1b,U.S.DOT Descripfico(including Proper Shipping Name,Heard Class,10 Number, 10.Containers <br /> HM and Packing Group(if any)) __ ers, 11 Total 12.Unit 13.Waste Codes <br /> 1 No Type Quantity WI,Nol <br /> 0i. : <br /> r <br /> 3 <br /> j <br /> 14 Special Handling liml-M-and Add-nallinw-isbon <br /> hIFF116ENG y 0 1- i <br /> '17N r .;" f71- ; <br /> , 11P. tn,�, f.1 <br /> 15. GENERATORI&WERORS CEFMFICATIGN:I hereby d8d"Vw N writents of this consowent are fully and accurately described above by the proper shipping narne,and are classalied,packaged, <br /> marked and(abeledlPlaurded,and are in all respects in proper condition for transport according 10 applicable international and nalJonal governmental regulatons.it export shipment and lam the Primary <br /> Exporter,I certify that the conlents of this consignment conform to the leans of the attached EPAAckrovi"menf of Consent. <br /> I certty that the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generstar'sIORenor,Pnnl—,ped�N.m. Signature Month <br /> Day Year <br /> �j 16 Interhatichal Shipnients, <br /> LJ import to U.S. Export from U.S. Pon.1 entry/e.if <br /> Transporter signature(for exports only). Date leaving U.S.- <br /> LU <br /> 17 Transporter Acknomackimenni of Receipt of Materials <br /> �Transporter Irintedrryped Name �tghalure <br /> 0CL r Month Day Year <br /> in ed Name -,' ,— 1 t <br /> Signature Month Day Year <br /> 8 Discrepancy <br /> 18a,Discrepancy Indication Space ❑Quantity ❑T" ❑Residue E]Partal Relent— ffl—U.I�1-1. <br /> Manifest Reference Number: <br /> 18b.Pilemale Facility(or Generator) <br /> U.S,EPA ID Number <br /> L) <br /> LL Facilftys Phone. <br /> 18c.Signalum of Alternate Facility for Generator) <br /> Month Day Year <br /> 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> T 3 4. <br /> 1 20 Designated Faulty Owner w operator Ce tib a on of receipt of hazardous materials covered by the onariffest except as—rdedm it—18a <br /> PnntedlType.name Signature Month <br /> 55T Year <br /> EPA Form 8700-22(Rev.3-05)Previous editions are obsolete. <br /> 1 GENERATOR'S INITIAL COPY <br /> R IF <br /> [,-I,Ay 19 2017 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />