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<br />Pleasq print or type. (For design or se on elite (12 -pitch) typewriter.)
<br />Form Approved. OMB No. 2050-0039
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<br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. (I DESIGNATED FACILITY TO GENERATOR
<br />UNIFORM HAZARDOU 1. Generator ID Number 3
<br />2. Page 1 of
<br />3. Emergency Response Phone
<br />14. Manifest Tracking Number
<br />WASTE MANIFEST CAM] 100Vt44
<br />2
<br />(a[t8)483--.1718
<br />00038857
<br />FLE
<br />5. Generators Name and Maitng4ddress A1'T'N[:YTMBRA ANDRFWS Generators Site Address(H different than mailing address)
<br />3A;4 dOAz)IITId i'Ol i SAN ,f(--AQhJ1N HOUSEMOLP }IAZARDOUS WAf31`P,
<br />161f) li F(F;?.LETON
<br />CA,1.F'ACI I.-T'1'v
<br />7550 J FU. UK!-DUL+1F0?ir `3'9'RE&`t'
<br />Generators Phone: [?il9j <,1 r, kl"-?G¢i6 3TGC GTC•N, C', •.±S;OrS
<br />6. Transporter 1 Company Name U.S. EPA ID Number
<br />E; ?J. :. ERV%Cf:S MA 1)U 9.', 22250
<br />7. Transporter 2 Company Name U.S. EPA ID Number
<br />8. Designated Facility Name and Site Address U.S. EPA 10 Number
<br />C 1., F.AN HARP_rik:; FNV SERV Lf•E5,
<br />30.4 AME.RTCAN f- TR.(
<br />Fi,6:1RA a:,, "IP f 7 ili
<br />Facility's Phone t""-'1 '-`'P"-117`'' iaT:'DU6979'i119
<br />9a
<br />9b. U.S. DOT Description (including Proper Shipping Na", Hazard Class, ID Number,
<br />10. Containers
<br />11. Total
<br />12. Unit
<br />HM
<br />and Packing Group (if any))
<br />Quantity
<br />P11.NnL
<br />13, Waste Codes
<br />No.
<br />Type
<br />4., .+ � rJQ 1);., N.O.S., ,[1INU ,..S,PGI:,
<br />iis:r2�=::1'2L11, (•p;'F4=J52Aj
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<br />U 01045..
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<br />2 FTAMMAB1E ^f LIPS OFir.ANTr',
<br />films^,
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<br />41.0.' 9.1,1147 :.:f,,PCLI, fEF!;:1'•`.)
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<br />A i I CSA63 {
<br />f,1) [A43021 IF, "FR -,:4:34 „ ([+:7!4"1'2)
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<br />011r65
<br />a Cclkir. `M; 5•TQIl BP JC ORGANIC,
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<br />it`:RG 1a,3 ICL':il•.;'-:"r
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<br />14. Special Handling Instructions and Additional Information
<br />749521, �. TiBCF',:,: 74452:', X 55 DM, 4: 7(4827,
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<br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, andare classified,packaged,
<br />marked and Iabeled/placaided, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipmenland I am the Primary
<br />Exporter, I caddy that the contents of this consignment conform to the tens of the attached EPAAcknowledgment of Consent. .-
<br />I certify that the waste minimization statement identified in 40 CFR 252.27(a) Of I am a large quantity generator) or (b) (if I am a small quantity generator) is true.
<br />Generator'slOffeeir's.Printed(Typed Namepf f- 'G/ ya /a Signature , on
<br />�"� 41q O rl
<br />. ay Year
<br />k+11� - sLf ^-✓
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<br />16. International Shipments
<br />❑ Import to U.S. ❑ Export from U.S. Port of enlrylexit:
<br />Transporter signature for exports onl : Date leaving U.S.:
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<br />17. Transporter Acknowledgment of Receipt of Materials
<br />Transporter 1 Primed( yped Name ..;9naWre Month
<br />Day sot
<br />CTransporter
<br />2 PrintedlIyped Name SigTb' m Month
<br />D Year
<br />K
<br />'
<br />r-
<br />18. Discrepancy
<br />18a. Discrepancy Indication Space ❑ Q ... fly ❑ Type ❑ Residue ❑ Partial Rejection ❑
<br />Full Rejection
<br />Manifest Reference Number.
<br />18b. Alternate Facility (or Generator) U.S. EPA ID Number
<br />J
<br />U
<br />Q
<br />LL
<br />Facility's Phone:
<br />W
<br />18c. Signature of Alternate Facility (or Generator) Month
<br />Day Year
<br />a
<br />z
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<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />o
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<br />2,
<br />3.
<br />4.
<br />20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as/reted in Item 18a
<br />Printerd Name/
<br />`.
<br />Signature Month
<br />j11ay Yea
<br />111
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<br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. (I DESIGNATED FACILITY TO GENERATOR
<br />
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