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Please print or type.(Form i designed for use on elite(12-pitch)4Tewftj Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number f 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CALOOYJ 25552 { t t! ^ '1 SKS c a s.+ , ! "i t 5.Generator's Name and Mailing Address Gene'fators S&Ad rd(if ren n mailing address) '3rt TE HtaraL0!F, I010SHAW k,. CA 9521-5 Generator's Phone: ?ryi rz Q•-; 4F,5 6.Transporter 1 Company Naive U.S.EPA ID Number T7Rf)1)0+`t393 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number ;.<Af'E�'I"Y-#�f�f~EN SYS'�'EtiS, 2A1`�. 000618 1'?`2 '*OOPE R CREEK ROAD OLH!'t1N, TX et3208 FadlitysPhone: 7 i iu3••�i2t�ii TXD077603371 ga. 9b.U.S.DOT DescriOHM(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(Q any)) No. Type Quantity WtNol. 1. f+pi � �i`iJb 'rti:3 i'C. Litirt3lD, Ij.rJ.a. ✓,t D-V �a t DOGS, D077, D006) 252 OUT Z 2. LU -'uk 1 - 3. ' 1 4. 14.Special Handling Instructions and Additional Information i j?R= rv1 K ^lRt,`1�#x1;;52�.�WvS GC;�3?4=335 -:�L' Errm:i1'� •7'C t •crvtu•T.IT 'r � tr ��x rcac n c.rn 15..GENERATOR'SIOFFEROR'S CERTIFICATION: I ereb�deo are that the contents of this con aignmenf a2 ly and accurately descn d above by the proper s ipD n9 name,and are classified,packaged, marked and labelecilplacarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if t am a large quantity generator)or(b)(if I afn a small quantity generator)is true. Generator's/Offeroes Printed/Typed Name Signature t} * r��1 Month Day Yea -j 1 16.IritematidnalShlpm*ants''' S tax if t i. ❑Import to U.S. ❑Export from U.S. P rt ofien'�ylex t: Transporter signature(for exports only): Date leaving U.S W 17.TranspofterAcknowledgmerrt of Receipt of Materials Transporter 1 PdntedTyped Name ) S' .-- r r F Month Year oCL Q Transporter2 PriritedFfype l Name ' 1 Signature Morkh Day Year' t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number V Facifi y's Phone: LU 1 Bc Signature of Alternate Facility(or Generator) Month Day Year a a V519.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) WO 1. 2. 3. 4. 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as now in Item 18a Printedffyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY i:; ? 4)