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Piesse print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.FAar festTracmng Number <br /> WASTE MANIFEST C:AD-7if,- -37�'T <br /> 1 009549039 J J <br /> 5.Generators Name and Mailing Address Generator's Site Address(if differeht than mailing address) <br /> k-S SrCtATEt7l•h',r.%TCI::S61qvid6 Sjt.7C. <br /> 1823 WE-Sr C H W,.P T C F.', /,. <br /> S'T0CKTr i J'.'Ilk 952CA3 <br /> Generators Phone: <br /> 6.Transporter 3 Company Name U.S.EPA ID Number <br /> -� IDES- <br /> 7. <br /> r.r.�•.��i Irl ��Ly <br /> 1:-.'_tii_ �r'ILC�_-C <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address ,r. .. I -^,, U.S.EPA ID Number <br /> nLir�i,r;C�;i�I�,Cc F.Eit Gr;I u'N.tD:n:G1�5'.'+I <br /> ,�13J twG;cTh IL�t E1rI°ILELr:aF•CI <br /> 1 r_t' ANGELES, <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quanlity WuVol. <br /> 1. PJ❑PJ 7.2Rr ,H -2ARX-1U r }VA-T E SCILID ( I?li a T Ei i F 181 <br /> O --- <br /> t- r_ <br /> z 2. <br /> LU <br /> 3, <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> PR iFILE# ERGW,7,1 <br /> E.F;. Cr1'.TF, .0-CtR: R.44u47G Ei'•!'', C3i'i +iEidfr,_ l 7'�fz�' (f <br /> HAw'tIOLEIRS 87HOLILD 6E <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,and are classified,packaged, <br /> marked and labeledlplacarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 21(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator'slOHeror's PrintedlTyped Name signature Month Day Year <br /> k-� <br /> 16.International Shipments <br /> 1:1Importto U.S. Export from U.S, Port of entrylexit: <br /> Transporter signature(for exports only): Dale leaving U.S.: <br /> w 17.TransporterAcknoviledgme of Receipt of Materials <br /> Transporter lPrintedTyped Signa e J f Month Day Year <br /> cn <br /> Q Transporter 2 PrintedlTyped Name Signature Month Day Year <br /> C� <br /> w 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ ❑Type y pe <br /> Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U,S.EPA ID Number <br /> .a <br /> V <br /> ►a Facility's Phone: <br /> LU 18c.Signature of Allernate Facility(or Generator) fulonlh Day Year <br /> B <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4, <br /> 20.Designated Facility Ovrncr or Operator:Certification of receipt of hazardous materials covered by the manifest except as riled in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> 1 <br /> EPAForm8700-22(Rev.3-05) Previous editions are obsolete ;i; :lGk!AYE I? ;';-`_:If_IY -F0 F) 01", <br />