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. - E 9EV 0 Please print or type.(Form designed for Use on elite(12-pitch)typewriter.) Farm Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Pagt;l rgergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST ICA2890090=' . _ - -1 . 925-423-4205 1005871080 JJK 5.Generators Name and Mailing Address Generators Site Address(it different than mailing address) taivmnce tivsrmrfe Naivnei L•b Sic ID an behalf d LE fv15A 11 +'rrence Gysrmacre NIstionai lb Sir ;m cn bel-aff ef L6 N&A faral PD- t3K 8]6 /L-786 tiuerrna-j- CA MI Hdlow Po3d Tram CA 95376 Generators Phone: T6-422-1425 AJTN: 9-iarlin¢ 6.Transporter 1 Company Name U-S,EPA ID Number NV amr- nmec't1:al Services CAT00062d247 b . 7.Transporter 2 Company Name US EPA ID Number B.Designated Faality Name and Site Address U.S.EPA ID Number t3menna tkrd=n (ATQ80013352 ILID Nath Aimeda V.GxmI3tnn CA M222 Facih y's Phone. X`-•527-7100 gat 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10 Containers 11.Total 12 Unit 13 Waste Codes HM and Packing Group{i any)) N Type Quantity Wt,Nol. sa1rbn-ASA hwardom Mssc kPId ILBEG 13L) M1700,50-A. 7r 1 00 1 r IY rrYr,•r.:ter. . ssncr-M;�:::»rr::�_Y m:*'sr s rr�r;r:rtr. _ 4 V 221 Z 2LU THIS V'lASTE STREAM HAS BEEN QUALIFIED FOR RECYCLINGfTREATsMENT AT THE RECYCLING FACILITY IN COlvif)TON.CALIFORNI THIS FACILITY HH.S THc PdC_CESSARY PERMITS TC i RECEIVE YOUR VlASTE..STREAM AS QUALIFIED. 4, t- :-5 t o i'JUiVHjCK I5 1,A1 UdUUl3j52r +w�rwn.+r�x,r��rr+:4•ax�+alsrrt+.r, .,n.,';r 14.Special Handling Instructions and Additional IniormaUon Enwgen^y Rxpanse Dans 512 i-423.3205. Ctarltact MMM LINL Prnergancy Dipatch. Lad x w.KL,-o1. 911p WC 0-5-246805, Fefrarence rdeai* rumbirr M0345 M tlwa_e. a]0]�7 COC20-9325, C�a�9Z-94- S0# I4D'3269(fr A/,R s � s��fi l ;.flc7�r � dmraq 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby'deciare'that the contents of this consignment are futly and accurately described above by the proper shipping name,and are classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent. I certify that the waste minimization sta'ament identified in 40 CFR 262 27(a)(it I am a large quantity generator)or(b)(if I am a small quanbltgenerator)iktrue Generatoes/Cfterors PrintedrTyped Name Signature , MflMh Day Year Smit A C-raham an behatf d tt US. NNSA ,✓li !`� � L � f�' —r 16.Imemational Shipments -- I-- 01mport to U.S ❑Export from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U S W 17.TransporterAckrxrMedgment of Receipl of Materials Transporter 1 PrintedlTyped Name Signature Month Day Year CL a Transpbner 2 PnntedrrypW Name --S'gnaWm-------- Month Day Year r 18.Discrepancy 18a-Discrepancy Indication Space Quantity ❑Type ❑Res due i ❑ aitial Reje0on El Full Rejection Reconciled quanfli I? Q with Marldit Reterenol Num, r, )� k f r 12O VS nwY - P-�t tBb.Memate Facanty i.or Generator) U Fadi.3ys Phone W 18c.Signature of Ahemate Fara ity or Generator) Month Day Y2ar Q Z S2 19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal and recycling systems'. q Z a. a. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 So Printed/Ty ��ped Namely S grature Month Day Year / -i/,, l'i f$bVI!1 I' �yJ- EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. —^ DESIGNATED FACILITY TO GENERATOR