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J <br /> /please rint'or. . Form designed for use on elite 12 itch writer: Form. ved.OMB No.24 M039 <br /> P kYAe.( 9 (12-pitch)}tYPe ) APPre <br /> UNIFORIWHAZARDOUS 1.Generator ID Number 12.41.p tot.'3:Emer ncyResponse Phone d.ManKastTrnw g' umber <br /> WASTE'MANIFEST (,.AJ-0M-55717 1 4t}923•$772 <br /> 5.GenaratVs Name and Mailing Address Generators SbAddrms(If dilfereatthan mailing address <br /> 0h1}c.)VR& L SVC RECYGUNG AIII'dt4lPllAf61 1P,f 1Qii`R <br /> 12M S,El Dorado tit. <br /> 'MOCFtan,CA <br /> Generator's Phone: <br /> 6.Transporter 1Company Name US.EPAIDNumber <br /> Uf C on P ''ft1G Unes GO { {# S$ Ct <br /> 7.Transpor€er 2 Company Name U.S.EPAID Number <br /> 8.Designated Facility Nam and Site Address U.S:EPAID Number <br /> RUC Ern hf [ <br /> f 1'it at Hifjweax 123 tJ` k-,G t22 i <br /> Facilitys Phone: <br /> •4 44,5t Int Garbm UT 8.4520 LGA <br /> 9a, 9b.U.S.DOT Description(inciudN Proper 5hlppinit Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit. 13:Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantify WLPM.,. <br /> t . d <br /> :rz a. t d� is {FFS.' ASIM,,SVi=M�it}af3'`Dl tegCn u' <br /> k Sa C°.?3 CSs`� ,,,1 t.a:3 a6' �` i <br /> W <br /> ZLU <br /> 2. <br /> 0 <br /> 4. <br /> 14.Special Handling instructions and Additional Information <br /> t.M&tRGAL SERVICE RMYCLIMftAp CARW, <br /> CI t 1 <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION*Iherbydeclare that the contantsofthisconsignmantare'Word amt*dw*edabove bythaproper-*9pftnorm;and aredassified,packaged, <br /> marked and Iat>a4adlpia rdad and are in all respects in proper condition for transportacc orft to applkeble Int wedonal and notl(nat govarnnontai regulation:If export stdprtiwart and Ian the Primary <br /> Exporter,I cartiy that the contents of th,'s=Wgnmont conform to Ute leans of the attached EPAkciehahiptlgme4of.Ccrisept. <br /> I certify that the wastemirumization statement iderifified(n'40 CFR 28227(a)(d 10 a,Iarge quarrtypr&e etw)0(b)(H I am a smallyg merator)is he. <br /> Generato s! era's nn Name ear <br /> f _._ <br /> 16.International Shipments El Imvm w U.S. D Export from U.S. Pat of entrylaxit <br /> Transporter signature for exports orgy): Date leaft U.S.: <br /> tr 17.TransponerAclaw,4edgm®ntofReceipt ofMaterials <br /> r Transporter fRnwryw Name Clayear <br /> [? ` � t "fit h <br /> T nsponer2 Print yped Name rhatrrre ® ear <br /> a'- <br /> 18.Discrepancy <br /> 18s.Discrepancy Indication Space ® Quanttty OTI" ❑Resufue Q RarUat Rajactia, ❑Full Rejection <br /> ?&nhst Reference Number. <br /> 18b,Alternate Facilk(or Generab r) U.Sf EPA'ID Number <br /> �-. Facil' s Phone: <br /> U, 18c:Slgnature ofAftemato Facility(orGni tor) Month Day Year <br /> 4 <br /> Z <br /> I. -19:Hazardous Waste Ropai fdanagernerht Methv;,lCedes(.e.,cndesfortwear&w w.ste baatrcent,ftpowjl and rsgatig systems) <br /> p t• 2. 3.. 4." <br /> 20.Des{nsled Facility Owner or Opemlor Certification of recelpt uf•hankfo u materials covered by the atarhifestaxceptas noted h ttetti 18a <br /> PMeayped Nama r } t th ay Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. ESIGIdATED FACILITY TO GENERATOR <br /> r <br />