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<Cob �. ,r✓''y'r*'1a . Please print or e. Form ved.OMB No,2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number 2,Page 1 of 33.Emergency Response Phone 4.Man�{e> ra�kt N Q(� JJ K WASTE MANIFEST U 9 1� Q o 5.Generators Name and Mailing Address Generaloed Site Address(if different than malting address) Lffwmnm UvCfT[wM WU01U1 LA Sft WO=6eW of the uS.NftraA Lawrom Lkvmw Q ItdCrIIs Lft S!W 3M CM b&1 w Cr t1M1 U.S.WaA P.O.B==/WN UWrtrerrtlr CA 94u91 Carm hok w Raaf,Trilmy CA 9537th Generators Phone: 96-422-M ATM 6.Transporter,Company Name U.S.EPA ID Number Clean Harbors Envifunmer+tM:rrefvtm Im 7 Transporter 2 Company Name U.S.EPA ID Number S.Designated Facility Name and Site Address U-S.EPA ID Number Marr H&rbOr11 lAlftU00 1,L ILC 1737 E Demi Sr„eet,W R"W"CA W7'44 CACXR442905 Fad. '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{d any)) No. Type quantity Wl Not. 1 WFACM hm>srds waste,14M 0AED 011)IOPQIIS M DM -W- X33 P 221 2 No*RM hazardous waft h (u,ED olij DDpttaU-1 S DF 2u P 221 3' NOCACRA he=Sous wawa„IWd1(USED QLJ DOPODAD•1 DF 41 P 731 4 Nor>t-RCRA hazardous Vd=e,tigWd JWD CKQ DOP0080-1 DM 20M 14.Special Handling instructions and Additional Information EnKrZOM ReVorm Phom,925423.47% CmMict rlamiQ U-ML Ermrgtxr Dlspa Ch.Load 9 AItUO-P2,Ship Ir No.s-251097. Seo liflmhed for Con r1t1t,m 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classed padseged marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations If export shipment and,am the Primary Exporter,I certify that the contents of this consignment conform to the tarns of the attached EPAAdmowledgment of Consent. I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(41 am a large quantity generator)or(b){ifl am a small quantity generator)Is true. Generators70Bemes Printed/Typed Name Signature Month Cay Year Batt A.Grahams an beha f of the Ux,NMA Ir Z !QI I,4 16.Intemabonal Shipments ❑Import to U.S ❑Expos from U 5. Port of enlrylexit: Transporter signature(for exports only): =fi Dale leaving U.S.: X 17.Transporter AclumAedgment of Receipt of Materials TransporterHR 1 P �i Typeraa�r C'2— Transporter Sgnahs� Month� ' D�� year / C tl 1 IL � Transporter 2 Pnn$ad1Fyped Name Signature Month Day Year N- 16.Discrepancy ❑Partial Refection El Full Raje+'tion ,6a.Discrepancy Indication Space ❑ Quantity ❑ ype T ❑Ressdue Mandest Reference Number. :1 ft.Altemate Facility(or Generators U.S EPA ID Number J_ V uu-- Facility's Phone tnu 10c.Signatureof A temate Facility,or erator) Month Day Year 1 . N19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) L� LLJ 1. 2. --T' qlq 20.Designated Facility Owner or Operator Certiircation of receipt of hazardous materials covered by the manifest excepttas noted in Item lea cin Name Signature Uointh O Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. � DESIGNAT�CILMY lQ GFNERAT?f