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r <br /> Please print or type. <br /> Form Approved.OMB No.2050-0039 <br /> �UNIFO:RM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone7019164884JJK <br /> Manifest Tracking Number <br /> AE MANIFEST C A C 0 0 3 0 2 2 8 g 0 2 1)88'423.6080 <br /> . enerator's Name and Mailing Address eneralors Site Address(if different than mailing address) <br /> PA r-und v1-NIIe{Ilttlt.Irltltel,LLC Att:Katttlt�en Let11�� <br /> r7Mi¢hal3on DrIve,SUIte 200 14800 W.SchuKa Road <br /> e. CA 02612 Tracy, CA 95377 <br /> Generators Phone: A 4 © 664 - 2 0 9 3 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Ani nkan 1111agMted SeIVI061i,Inc. C A R 0 0 0 1 4 8 3 3 8 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S EPA ID Number <br /> Crosby$$Owa ton,IRC. <br /> 1630 W.1701%tot <br /> Lang eeadt CA 98813 <br /> Facility's Phone: 562 432-5445 C A D 0 2 8 4 0 9 0 1 9 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10 Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No Type Quantity Wt.Nol. <br /> o Ui 11930,W13YE Aerosols,,2.1 DOO1 331 <br /> 0 <br /> DMIngP <br /> z. 1133 66,tIW35'IE Corrosive LiquW,Brisk,lnorgank,N.O.S., f 3-0 D002 141 <br /> (SodEum HydroA&),8.t011 <br /> C <br /> 3. U41 C,32,WASTE SUlUt Add,Slant,8,PCA1O ( J�C� D002 133 <br /> Jit' U <br /> 4. Non-R RA Haaardous Waste,LIquld(Hyd eWic/Engim 011) 221 223 <br /> Q DM 50 <br /> 14.Special Handling Instructions and Additional Information <br /> Wear appropriai:e PPL while handling. Weights or volumes are approximate. <br /> F�IIs Project X39150 <br /> Sb.l ) Profile #1.12402 91x.2? Profile 4105837 9b.3) Profile # <br /> 9b.4) Ps-ofile #90169 <br /> 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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental 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 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. <br /> Generators/Offerors PrintedfTyped Name Month Day Year <br /> 011 bel latt of Gumerato► ine� Signature 7 1 <br /> J 16.Intemational Shipments <br /> ❑Import to U.S. Export from U. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.. <br /> 17 Transporter Acknowledgment of Receipt of Materials <br /> LLJ <br /> Transporter 1 PdntedfTy*Name Signature ( Month Day Year <br /> Z Transporter 2 PrintedrTyped Name Signature Month Day Year <br /> F— <br /> rDiscrepancy <br /> dication Space Quantity ❑Type Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> lab Alternate Facty(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LA- Facil ty s Phone <br /> W 18c Signature of Aftemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 0 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � y. 3. 4. <br /> W 1 <br /> 0 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedfTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />