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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS i•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CALM417"I j j-a.7s.7nj Q 10243216 F L E 5 Ge�neroor's Name and Mailing Address Generator's Site Address(if different than mailing address) �8�1N1V� Skoftril, CA 9W5 Generator's Phone: 1 M2 ransponer 1 Gornpany Name U.S.EPA ID Number AftwkW C I01"TfX"Pnd kv. (S/) CAFOODOMM 7.Transporter 2 Company Name U.S.EPA ID Number 8 Designated Facility Name and Site Address U S.EPA ID Number 1.7�i # T"1111011111111" Abl NM 91107 Faclity's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(it any)) No. Type Quantity VA./Vol. 11VO&RIM Hilloo"M w8we Scud(00Y Sobs) !� -� z 2. W i 3. 4. s 14.Special Handling Instructions and Additional Information MNY*W 124M7 Qoo11111111AW it OHN12 1) ACT64M MW Jf-I 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,and are dassified,packaged, ma*ed 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 am the Primary Expoger,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I ceMfy that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(it I am a small quantity generator)is we. -j Ieneraior s Pnntedffyped Name Signature it 9n ay, 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Pod of entrylexit: Transporter signature for exports ont Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials � Tran i P Name 2n r a a � � d U) Transporter 2 Printed yped Name nature on ay Year H 18.Discrepancy 18a,Discrepancy Indication Space ❑ Duartily ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Faci:ity(or Generator) U.S.EPA ID Number J U Q Facilitys Phone: w 18c.Signature of Altemale Faci'dy(or Generator) forth Day Year Q Z (, v, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1. 2. 3. 4. 4-/&// - 1 20.Designated Facility Owner or Operato:Certification of rete" hazardous materials covered by the manifest except- noted in jorn 18a Prntedrryped Name Signature Month D/a�y Year/ EPA Form 8700-22(Rev.3-05) Previous editions are o sotete. DESIGNATED FACILITY TO GENERATOR