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f � Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS V 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4 Manifest Tracking Number WASTE MANIFEST JJ K 5 Generator's Name and Mailing Address Generatoes Site Address(if different than mailing addressl (ACTOR 3 U.1.O C.:`- W CA,RWG$E ST. MAh7ECA.CA X3331 Generators Phone: r�).il39-9`fi'' 6.Transporter 1 Company Name . 17 a U.S.EPA ID Number .;iEr49'i '.'v LA«ry W • Transporter 2 Company Name FEB 0 U.S.EPA ID Number 8.De clh)y Name agil SigMsh US EPA ID Number ,��,.� _ ENVIRONMENTAL 530D CLAJUS R11 HEAITI i 1}F:P:.RRTMFNT RIVERSAW,1"A *6W, Facility's Phone- 9a hone 9a 9b,U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID NumberIa rers 11.Total 12.Unit HM and Packing Group If any)) t 'v �pe Quantity WLNol. 13.Waste Codes .; 1' f:l�TJ R�Ra. Hf•ZF_RDOu.t$ '�� LK?ltl(7 r•?rtr +r.�en w Z LU C) 14 Special Handling Instructions and Additional Information t_,SE s' OVIE"r GEN ERATOR'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 classified,packaged marked and labelediplacarded,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 Pnmar, Exporter.I certify that the contents of this consignment conform to the terns of the attached EPA Acknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity gen_ r)or(b)(91 am a small quantity geperator)is true Gener5 s' eror's Pnntedl Typed Name gnatuleMontt Day Year 16.In nal Shipments � ❑Import to U.S. ❑Export from U.S. Port of entrylexlt: Transporter signature(for exports only): Date leaving U S.: w 1 i.Transporter AWiowleogment of of Materials c Transporter 1 PrintedrTyped Name ( Signature 1 Mo Day Year a Z Transporter 2 Printedffyped Name Wrilln D y Yea, 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number J_ U W Facility's Phone: 0 18c.Signature of Alternate Fac;Ry(or Generators Month Day Year H Z z Cn En- 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) cw] 1. i 2. 3. 4. 20 Designated Facility Owner or Operator:Certification of receipt of hazardous matenals covered by the manifest except as noted in Item t Be PrinledfTyped Name f Signature Month Day ear EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR A