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a <br /> print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050.003 <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2.M71Plage 1 of 3.41"23-9772yResponse <br /> espPhone 4,Mantfsst Tmoking Number <br /> WASTE MANIFEST 7 <br /> 5.Generatoe's Name and Meting A 0 Y ReCC�T� CGa nests Ola Cdd. t then mailing VMDA&SVss <br /> 32M S.El Dorado St, <br /> 6clito,CA 96206 <br /> Generator's Phone: <br /> 8.Transporter i Company ams U.S.EPA ID Number <br /> Uni?,fI Pacific Lines Ctk'i792 ifl <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated FadO/Name and Site Address U.S.EPA ID Number <br /> Er-Or; fi?+krf l r ra S�r1 d <br /> 1iIiWest x'123 �r"ie Gd�lib4„ <br /> Facility's <br /> -4451 East Cafbcm,16% FM USA <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Untt <br />� 13.Waste Codex <br /> HMand Packing Group('rf any)) No. Type <br /> (quantity y ryNo{. <br /> l 1. X91 <br /> I a P,10Ni P,+, APCILXl-'l ASTE,56UD ill"°°yrs-I OT r d) Ali HG, T <br /> r— <br /> Z 2. <br /> ul <br /> I 4. <br /> r <br /> 14.Special Hand]mg 140mtions and Addit alai Information <br /> L#411. R AILV-RECYCLl . L✓ 6�e t om <br /> G-RCS adder t . Uo <br /> ,1)C P 1 16 <br /> 15, GENERATOR'S(OFFEROR'S CERTIFICATION: I hereby dedam that the contents of this consignmnt are fully and accurately described above by the proper shfpphng name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper cwo2o n for t ansport according to applicable international and national govammental 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 attadod EPARckrov8edgmetnt of Consent <br /> I certify that the waste minimization statement identified In 40 CFR 282.27(x)(d I am a large quantity generator)or(b)(ii I am a snag quantity;genemtor)Is true. <br /> General sf mils RnOTYR NamemormY <br /> r- f <br /> J 16,International ShipmentsEl <br /> Import to U.S. ❑Export from U.S. Port of iiftIexrL <br /> Trans s"natum for exports only): Data leaMu U.S <br /> tr 17.TransporterAd nowiedgrawt of Reo*of Maroriais. <br /> .Transporter)PrintadlfypedName n y ear <br /> a ' <br /> 17 14 11f, <br /> zT spo fer 2 rintelyped Name Month Day Year <br /> 18.Discrepancy <br /> f 8a.Discrepancy indication Space Quantity ❑Type ❑Residue ❑Partial Reja6. ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate FacFity(or Generator) U.S.EPA ID Number <br /> J <br /> to <br /> uu. Fad] s Picone: <br /> 18c.Signature of Alternate Facility(or Ge,aerator). Month Day Year <br /> Q <br /> 19,Hazardous Waste Report Management Method Codes Q.e.,codes for hazardous waste Inntrnent,disposal,and rec}cling systems) <br /> LU i. 2. 3. 4. <br /> LJ I YI)Z <br /> 20.Designated Facility Owner or Operator.Certification of recut of tiaiardous materials covered by the manifest except as noted in Item i 8a <br /> Prin YPed Name Signaturer <br /> 'ji <br /> EPA Foran 6700-22(Rev.3.05) Previous editions are obsolete. S)GNATED:FACILITY TO:GENERATOR <br />