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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 `UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CA-0 98 I to to a B 4 y 81-24-930 0 011682172 J 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) pep 6orfs 40 �-rke ee 0 -00P pe_p Baq-� :w--"?ff ®rcharel t4g8Q weS•4 Lc-j. y4ra7)MC -)40+Z ; IJ,, 0 SQ37 5-E0cK+or) c-4 q50-1 10 Generator's Phone: p Gd 4. <k<\ 6.Transporter 1 Cm an N e U.S.EPA ID Number oFLUMS CAL000381082 7.Transporter 2 Company Name U.S.EPA ID Number NONE 8.Designated Facility Name and Site Address U.S.EPA ID Number CR0 SB Y&OVERT 01-T 1630 W. 17TVSZR.EET CrAD02£409019 Facility's Phone:LONCs BEACH,CA 9N13 56143 2-55445 ga. 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(if any)) No. Type Quantity Wt.Nol. 1. 352 1,TON RCRA HA.ZP.RDOUS WASTE 001 Dim r r?5 R z 2. w 0 - 3. E 4. 14.Special Handling Instructions and Additional Information 9bl.USE APPROPRIATE PEMNAL PROTECTIVE EQUIPIVENT - APPROVAL#20234 15. GENERATOR'SfOFFEROR'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 certify that the contents of this consignment conform to the terms of the attached EPAAdmowiedgment of Consent. jI certify that the waste rninimization statement identified in 40 CFR 262.27(a)(H I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Gen a s/ ror's drryped Name S n re Month Day Year 6.I6tema8onal Shipirrilmd €- ❑import to U.S. ❑Export from U.S. Port of entryfexlt: Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year CL Gt?i l�rialy ' Q r'c lla r, Q -- 8 a a 11.3 Transporter 2 Printed/Typed Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year B Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designated Facility Owoer or Operator:Certification of receipt of hazardous mate0als covered by the manifest except as noted in Item 18a PrintedlType me Signature Mores Day ear Xl2* EPA Form 8700-22(Rev.3-05) Prelvs editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)