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• <br /> Please print or type Form Approved.OMB No.2050-0039 <br /> 1 Generator ID Number 4.Manliest Tnckin Number JJ K <br /> UNIFORM HAZARDOUS 2.Page 1 of 3.F�nergency Response Phone 10213 <br /> 2 u 6.3WASTE MANIFEST CAt 4afjt$-r' 9 1 <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br />. f'P1ERPIANT LANOM/y7'r1 r r -1 f��y•/,[s r �1 <br /> fCx:KTrf CA 96219 <br /> VFacility'sPhone: <br /> Phone`.?'= "a 1-r'-?d:t <br />• ter 1 Company Name U.S EPA ID Number <br /> N f�­?,`l,-":, ;., t - r, <br /> p .3 1R3Alfdl-fi'r.-j MiG a,LiGddC['� ,.F <br /> U ter 2 Company Name U.S.EPA ID Number <br /> J <br /> Im <br /> T ed facility Name and Site AddreSS 1. U.S.EPA ID Numbery �' A <br /> ._.� +'e+L^ii'.; C tdf�aOr..!i'C.cT Fit 1 ,_l.✓f`ry �Fflt{ri. <br /> 31SC�k A57 �1.Ct? r',LVD, <br /> /.,- �r rry Gr 5,C4, `Icop C�l 2)c�w:?�,'r � �C-5 <br /> hone.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number. 10.Containers 11.Total 12.Unit t3.Waste Codes <br /> 5 d Packing Group(if any)) <br /> 0 No Type Quantity Wt Nol. <br /> u 4 1' k <br /> LU <br /> 4 <br /> . m 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> I; ERf,M,16 9&2>oRC1FItEo MGM.53 -�>- <br /> 3 �• t.+_�r?„t�:.;U4? (�.L.}„;rr F..�IVIt+f2idt+r1E1+1TP.L. - <br /> L*NDLMS RHOULO EWC'I'PAM O AND USEE APPROVED PF'F - k 4;- <br /> c <br /> m <br /> z <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 Pdmary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknov4edgment of Consent. <br /> 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. <br /> o Generators/Otferor's PrintedfTyped Name Signature•- . Month Day Year <br /> a <br /> 16.International Shipments <br /> w ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> 9)� 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> 11-- Transporter 1 Pdnted/Typed Name Signature O 9 Month Day Year <br /> d <br /> y Z Transporter 2 PrintedfTyped Name <br /> Signature <br /> aMonth Day Year <br /> 18.Discrepancy <br />'. 18a.Discrepancy Indication SpaceType Residue ❑Partial Rejection ❑Full Rejection <br /> ❑ Quantity ❑ ❑ <br />„• 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> U.S.EPA ID Number <br /> J <br /> v <br /> LL Facility's Phone: <br /> • a 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> S219.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> QUJI 1. 2. 3. 4, <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> i' Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />