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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) ` . Form Approved.OMB No,2050.0039 <br /> 1.Generator ID Number 2.Page I of 3.Enency Response Phone 4.Marthst Tracking Numbar <br /> UNIFORM hAZARG0U3 �i f?fIO3ti57 I i t9 +.•2S S7 t1 ' <br /> WASTE MANIFEST <br /> 96 FLE <br /> 5.Generator's Name and Mailing Address Ganerata s Site Address(if d'dferent than Fairing add <br /> 9A-If:REC'YCLt�tO Ain ress) <br /> I;rFt�A.i: �rtlH�rt`[ vig <br /> 21[kl S.Et Dorado SE, <br /> SA00.1:0'CA. <br /> Generator's Phone: <br /> fi.Transporter 1 ny Name U.S.EPA ID Number <br /> Won ftc�,i <br /> T Transporter 2 Company Name' U.S.EPA ID Number <br /> 8.Designated Facil ty Name and Sile Address U.S.EPA ID Number <br /> C'D(�'Envimirimeritalliso FP ao;�J s is i <br /> I f 1 1 west FIftg"123 <br /> s�1-- -44131 d=am CaM' (n,ski` a4626 USA <br /> Faoiiity`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(i€any)) No. Type Quantity WtiVol. <br /> T <br /> I � 1 <br /> LU <br /> 2. <br /> CD <br /> 3. <br /> 4, <br /> 1d.Spacial Handling instructions and Additional Information <br /> UNNEnALRtCYCLMPROJECT MLCAR W, / zy <br /> IIF Cu $f RE I <br /> i 16 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment aro fully and accurately described above by the proper shipping name,and are classified,packaged;';' ` <br /> marked and labeled/placarded,and are in ali 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 AcknoMedgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 252.21(a)(d I am a large quantity generator)or(b)(d ljp a s_Mj qu *generator)Is true, <br /> Gerwrator'sr rs PrinWffyped Name ria re on ay ear <br /> / / <br /> J 16.International Shipments �'1 <br /> I— L-.l Import to U.S. El Expod from U.S. Porl of entrytexlt: <br /> Z Transporter sinature for exports only): „! Dale leaving U,S.: <br /> 17. nspodE'Ackxt+6e4f9mantof�ecelllt fMalaralsr a F yc <br /> a Transpaterf Printedflyped Name ..,Signature ay `' ear . <br /> a A i <br /> ZTransporter 2 Printed/Typed Name sgnature oath y ear <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type Residue Partial Rejaction ❑Full Rejection <br /> Mar rest Reference Number, <br /> 184,Alternate Facility(or Generator) U.S.EPA ID.Number <br /> 3 <br /> W. Fora+ s Phone: <br /> 18c:SgrlahreofAlternate Fac ty(orGenerdtar} ip Day: --Year <br /> r <br /> Z <br /> 19..ttazadaus4VastaReport lfanagamentNaMscdCod"Iia codesfdeharardoitswas'tetreatment;tks0ssaf,'nd he t4i items) <br /> Uj f. 3 I r 2. 3. 4. . <br /> lt_ 4 <br /> 20.Designated Facility Owner or Operator Certifioa8on of receipt of hazardous materials covered by the manifest except as noted in Item IM <br /> Pdntedtlyped Name gnature Month Day {{Yeeaapr <br /> ' t r x r': 4 P <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete, DESIGNATED FACILITY TO GENERATOR <br />