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f <br />Please <br />r. r .. <br />,. tax— d ed 1,., e n elan f19n rrm ...aUllfc 1 <br />V)b 6 <br />V� a Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05)' Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />r lYe. p <br />UNIFORM HAZARDOU'S <br />WASTE MANIFEST <br />1 era IDN' uqtuber �\\� <br />t 1 1 W J V '.. <br />2. Page 1 of <br />3. Emergency Response Phone <br />/ �, <br />4. Manliest Tracking Number <br />000894533 FLE <br />5 eneratorsN me and Mailing Addres Generail SileAddress(if different than Mallin addres <br />�cx�cjU►n ' 5ollci waste 1),vlslon }tN K1mN�ra. �n rPws <br />n o <br />UR tSto San Joaquin C a3 �ehotd Lill <br />Gene ne:F--�on C� G5aU! a.©�1 `•flDa' 17850 S. 12A13r�d e:orcl i• a:�n <br />. r acrier i Company Name U.S. EPA ID Number <br />EI n ylarLbn Emir a nom, c CV;Lrb e• P: O-?)G3a0-Xd50 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />Facility Name and Site Address LIS, E AID Number <br />6. a ignated l.. <br />��Ki�� 1-1arkX>rsEnult-ot�rp��r�kai �er��c�(•,n-�lx.0 Fac�lr �`) <br />t h t G `45 <br />SoPhone: � a35• act! �l E: laq 81113513 <br />Fdt)l'7 IN�v`1 <br />?S it bax 36 <br />9a <br />HM <br />91b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (it ani <br />10. Containers <br />11. Total. <br />Quantity <br />Unit <br />bNol. <br />13. Waste Codes <br />No. <br />Type <br />'�'lammahlerl( u�d il•o•'S.(T-htnriersr�le <br />b5i_MaieZ' ' <br />t <br />81U�' <br />ly1 <br />X <br />(.�Nw),'3,UI-\1gG3jAG 1! <br />i <br />u) <br />-V555 <br />N <br />Z <br />2.AIiZe�� K1 Illa4erlo ( C�cxi,lt-Thlnne� <br />(vt <br />"x <br />11 p�y- ��jeq PK1 ay(Ni�lw),3,uniaLo3,aGI1 <br />11 <br />CF <br />1ii's4ao <br />l7 <br />N k <br />_ <br />3'�Q►Z��7IQif't`� iY1Ah f' r tG I �1 l rli-T�'1t+ln£'.r`r <br />c��1�5 <br />CD io) <br />�( <br />011 eIcSrb 'Pat V) (FkNW),3,IAIIwsp3) oG %I <br />N !Z <br />X <br />FlGmm�1� SottC'I,t_'trganlc.. f� •05. � i , . <br />Ldn 1?�S, uG �1 CPp.hestve.,�te-oi•eua�`,slt1 <br />� <br />�'S) � <br />, F <br />�- <br />.,13s <br />�' <br />� <br />11 <br />_ <br />14 StiaIH andling Instructions and Additional Information F (ry '"' ! e., 7 s) <br />1•Ct��yoCCoa► ia_x55Dm ; �.)c►4awoc�a� x m��; �.jellawr <br />A4• CHa�©got 7--�- x crus 1 F 1 fol der +I 5N-tC\o4(o , Uv31555-oo <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by th roper shipping name, and are dassited, packaged, <br />marked andlabeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />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. <br />e ratar's/ Printed(Typetl ameigna ug)Month Day Year <br />16. International Shipments <br />❑Imponto U.S. Export from US, Pan of entrylexit. <br />F <br />Transferrer signature for exports only): Date leavin U.S.: <br />W <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transp rnted/Tgped Name Signauffe Month Day ear <br />Aj <br />za <br />Tran over 2 Printedflyped Name Sigaat re L 15 - onN Day ear <br />16. Discrepancy. <br />t <br />16a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />16b. Alternate Facility(or Generator) U.S. EPA ID Number <br />J <br />U <br />W <br />Facili 's Phone: <br />16c. Signature bf Alternate Facility(or Generator) - Month Day Year <br />a <br />z <br />N19. <br />Hazardous sets Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />1 _ <br />2' o fo, 3' <br />4- <br />20. Designated Facility Owner or Operator: Genificetion of receipt of hazardous materials covered by the manifest except as nitted in Item 1 B <br />ledrryped Ne ture Month Day <br />EPA Form 8700-22 (Rev. 3-05)' Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />