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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 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST %r L.0 O O�S 6�s? � (800)r)'24-4)30)6 018170040 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) HOU OF CALK=OkNIA- kCC44• ;47i 0'76 1.521 WEST CHAP,T E ''IVAY S411-jcil'7"ill, CIA Z1�11;1206 GonoralorsPhone G.Transporter 1 Company Name U.S,EPA ID Number ','C"i:1l D(JIL EtitiiI"0NN1ENTAL._Ei i.:E.: C A U U 2 6 2 r ' 10 3 E 7.Transporter 2 Company Name U.S.EPA ID Number V:vF,hUW�(Lfia. t� i„�rLr'. C�; ,uf,9 (f°lU CAR0001154 ' B.Designated Facility Name and Site Address U.S.EPA ID Number Ef'11�Eit'i, ilei: iZ 000521 .1. 46 Facility's Phone: , ga 9b.U.S DOT Descnption(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total Q.Unit HM and Packing Group(if any)) No. Type Quantity Wtivol, 13.Waste Codes tY 1.f�•Ji�-F :r A i I A •`F D,'-,JS "'ir ` "1 C .C,L1D 1''-dLY'.'0L-iC' z 2. W i 3. f 4. 14.Special Handling Instructions and Additional Information , / D p t f.ti R(',EN[,Y C 0t'4 TACT , t:H1l`,AT1`1'EC 1-300-,124-0100 WOF:!,TEPfAINAL: CEREISN S NAERG#^x131 : 171 PROFill#9f)i 1Ei2623NRS-HOL025 OILY S,iLIDS - -'APPR(D,11RIATE PPE EQuIPh1Ew- 2 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping narne,and are classified,packaged, marked and labeledfplacanted,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 EPAAcknowtedgment of Consent. 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. Gen atoes/Otteroes PrmteofTyped Name Signature Month Day Year -j 16,International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entrylexit: z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials 0 7ranspo i nn [Typed Name Signature Month Day Year rC�11 G/ CL QTransports[2.PrintedlTypedName Signature Month Day ear 05 f��.�-Wit_._. ��/ / 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑ j J Partial Rejection ❑Full Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: W 18c.Signature of Allemate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. 20.Designated Facility Owner Op rator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item I8 Printed/Typed Name Signature Month Day Year Q EPA Form 8700-22(Rev.3 0 Previous editions are obsolete. DESIGNATE FACILIT T ESTINATION STATE (IF REQUIRED)