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r <br /> ,se print or type. <br /> UNIFORM HAZAR DOU5 I,Gw.erator ID Number Form Approved.OMB No.2050-0039 <br /> WASTE MANIFEST t <br /> 2.Page 1 of 3.Emergency Response Phone •11 4.Manifest Tracking Number <br /> �r <br /> �� <br /> 5.Generator's Name and Mailing Address � SCJ •. i K <br /> ti <br /> Gener rSitedres rf di rent 1 <br /> C a mail <br /> ti � g addres� <br /> TMM <br /> �Generalor'sne. <br /> 6.Transporter 1 Company Name <br /> Etu _PA ID Numbe. <br /> ULT=�,N1E Vhf IROWOE NTA,LIN1 - <br /> 7.Transporter 2 Company Name ! U.S.EPA 1D Number <br /> 8.Designated Faciitty Name and Site Address U.S.EPA ID Number <br /> rLEA,1�TECH E�.'1t1�€Ul�F.iEtUT a,L II�O <br /> ,.. . <br /> 5820 Il RTIN ROAD CALDQP3.3 3 <br /> IR'Vr INDALE,CA 91706 USA <br /> Facility's Phone:62£-312-f 2-bG <br /> ga• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12.Unit <br /> Hp� and Packing Group(if any)} 13,Waste Lodes <br /> Nc. Type Quantity WI./Vol, <br /> 1. NON- VOA HAZARDOUS WASTE SOLID(ASSORBENTJPAPEFS FILTERS r/� !9 DIM r P 352 <br /> a <br /> LU <br /> 2-1 w 2. NON-PC RAZ, RDOLJS%ASTE SOLtU(OILY SOLID WASTI=IL15ED � DNI R 352 <br /> fdETAI-OIL FILTERS) <br /> -�-;+1�51-f�+�-s�-#���Es!+;-�r���..���tt��f:"D•.r�f��F'�i�PT'j'� -- L�,-, - F» _�� -- .` -- <br /> 4, <br /> 14.Special Handling Instructions and Additionalrmation <br /> 3E►1)PRQFIL.E#'4T�i_ 6) ROFILE# rILZ �F-Ftp USE GLO"VES F\F40 GOGGLES Ti JgKER#� <br /> (PPPERFILTERS) (METALFJLTERS) <br /> i..�LLEF� MUST IDE14TIFY GLEARTEOH EWr1FsONMENTAL AS REGISTKANT: INFQTKAC 590-535-5055 <br /> 15. GENERATOR'SIOFFEROR'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, <br /> marked and habeledlplacarded,and are in all respects in proper condition for transport according to applicable internalionaland national govemmenlal 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 Acknowledgment of Consent. <br /> I certify that the.wasle minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quartily generator)is true. <br /> enerato <br /> ,'sferos� 's PrinledlTyped Name Signature Month Day Year•. <br /> 16.International Shipments <br /> ❑lmporl to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Data leaving U.S.; <br /> 17,Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> F- Transporter 1 PrinledlTyped Name Signaiur Month Day Year <br /> z Transporter' nntecilyp N a Signature Month Day Year <br /> a- <br /> 18.Discrepancy <br /> 18a,Discrepancy fndicaton Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Ful Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) r ` U.S.EPA ID Number <br /> U <br /> Facility's Phone: <br /> H18c.Signalure of Alternate Facility(or Generator) { Month Day Year <br /> a - <br /> z -- <br /> t 9.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1• )�. �� � 2. � � 3. 4, <br /> 20.Dnsignated Facillly Owner or Op alar:Certification of receipt of ha ous materials covered by the manifest except as noted in I `In 18a <br /> rPflntred��Typedme Signature Month Da Y ar <br /> 1 y <br /> EPA Form 8700-22(Rev.1.2-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br />