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•:'L ICK :SHIP# 2wlTi4,S4r''-408 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Farm Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number SKS�[(� WASTE MANIFEST "s<`6-IL.?'+:O1 t--fit :i 1-..�S�d)o�.-41ir~ -L!fiu'� 005t521946 �7nV 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) �rI :� I! F;.;��;� ��n Rubbe, 95236-9455 ECEIVED Generators Phone: 2013-6s"7-1= � 6.Tran rter 1 Company Name U.S.EPA ID Number ;� rr' 4..> r� ~7��tr # , :i NC. SEP 3 0 ZO1 T�;+��I�u�i?r�_(wi[�,? 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address (,I-EAN HAEfBEIRS SAN .�i�`�e .E D Number 1@21 BEER YESSA ROAD DEPARTMEN SAN V)FIE x I"p 4' 6. 60( IATOY. 49-43 310 FaclIVs 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 WtNol. 1' :�?€,Z•17t �, f I.AY�ttpF{i�tiU S A i I�C v LIMUM:)av y p `t'� n �+, P L-008 Dole 22 0 ids �.).Cys q (E.,EA04 F%1:.`f.7'CtLl:::g 9 PS 1 S.i L ) 2. UN 7 i� �$a�l�:� FI )�aiE;1T�1 r. �,, 1�T��, FIM P �'�:M F002 x•00 Vii,l7. GI .f i OI-E.um OIL. ��N5 ?iii �.'t-lt r) , � q.d 3, �� 2E11 FZQ5 11001 214 3' NOt'�l'k=.�-i+1."�.N E:Mi�14 !-li��F:s�D1,�(I�s vd3 SIE ;�'s tE..m iii( n 00 I�` 3�rC 4. 14.Special Handling Instructions and Additional Information .-(�_ i i,i i.�'i� '��! �T.-9So308 1)ERG#171 -,2)LR6#' 12 24 FIR I„K RKENGY #1100-468-1760 468--1°760 :6K. TF 1) I ., t ,a Fsr .,w " ra By t. ,• .- C: " 1 3 r, .-,• QS T.r.s� 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,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 Primary Exporter,I certily that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. 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. Generators/Offerors Printed/ryped Name Signature �^ Month Day Year 16.lntemational 1 ants Eli` Import to U.S. ❑Export from U.S. Pdit of enby/exit z Transporter signature(for exports only): Date leaviag U.S.: W17 Transporter Acknowledgment of Receipt of Materials 112 Transporter 1 Printeffyped Name Signature Month Day Year d Z Transporter Pdntedfryped Narje Sig r tore Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue DPartial Rejection ❑Fuil Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA ID Number J V tai Facility's Phone: Month Day Year 18c.Signature of Alternate Facility(or Generator) 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1, 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the man'rfest except as noted in Item 18a Printed/ryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05)_Previous editions are obsolete. GENERATOR'S INITIAL COPY j) "iC-' I";':T.•�1...-i+11A_r9 j.It- �5 ,. .�.C':� '}:.:�..�F`�'i.:.':i' +:} "'�...t.�':.'�(.�..'��S',.'. ,'^i.;%