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I/ <br /> Form Approved.OMB No.2050-0039 <br /> Please pont Or type. 4.Manifest Tracking Number <br /> 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone 9 <br /> UNIFORM HAZARDOUS888 V3 01916 4 8 8 5 JJ K <br /> WASTE MANIFEST C A C O O 3 O 2 Z 8 6 O 1 <br /> A 5.Generator's Name and Mailing Address All:Ka011:ae11 I.t d1,aflofenerator's Site Address(it different than mailing address) <br /> LBB Fund V14AM IndtlWtal,LLC <br /> 3347 Mlch(A4*n DOW,St110t 2W 148Wo W.Schutte Road <br /> h-Ane. CA 92612 Tracy, CA 96377 <br /> Generator's Phone: <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> o Atstericen It9891310d Su vk*s,Ine. CAR 0 0 0 1 4 8 3 3 8 <br /> U S.EPA ID Number <br /> J 7 Transporter 2 Company Name <br /> n U S.EPA ID Number <br /> r, 8.Designated Facility Name and Site Address <br /> Cwaby a Ove don.Inc. <br /> 1630 W.I M(teat <br /> Long Reach CdA 901313 C A D U 2 8 4 0 9 O 1 9 <br /> Facility s Phone: E,62 432-6445 <br /> ga. 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)) No. Type Quantity Wt.Nol. <br /> 0 1 UN1993,WASTE Flammable Ligtdds,N.O.S.,(Lsbpack).3.M11 DOO 1 331 <br /> $' OIA 2 10 G <br /> i UJ <br /> UJ z UNI M.MSIE Hydreahkwk Acid.8.PON 01702 133 <br /> r o U1= oZ G <br /> i - <br /> 3. IJjin-R(:RA Hazardous M36,Sold(O1-ease,ON MOM) 352 <br /> Loulin <br /> m <br /> O 4 - pp <br /> m X 7 la, WprsT� 4 -Alx c, 5atu+iaht19 <br /> Tf <br /> ' 14.Special HandlingInstructions and Additional Information <br /> t <br /> War a11 rulrri.ate PPL wlri jr handling. Retghte or vo.lunlea are approximate. <br /> 3 AIS Project 139150 <br /> 9131.1 Profile 'i 9b.2) prof,Ue l 9b.3) Profile f <br /> Z by l <br /> 9- 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 /> i marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable intemabonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPA Acknowledgment of Consent. <br /> LUCGene <br /> tify 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 /> os/Olfer-es Punted Typed Name Signature/ L Month Day Year <br /> i Nt bel le f of Gteneiator �� FP�t_ `� --�. 112- <br /> tional ShipmentsImport to U.S ❑Export from U.S. Port of entrylexitr signature(for exports only): Date leaving U.S.: <br /> rterAdunowledgment of Receipt of Materials <br /> r 1 Printed/Typed Name Signature Mo>t Day Year <br /> L Z Transporter 2 Pnntedrryped Namer Signatur Month Day Year <br /> H <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> ,. 18b.Alternate Facility(or Generator) U.S EPA ID Number <br /> J <br /> V <br /> Facility's Phone <br />( W 18c.Signature ofAffemate Facility(or Generator) Month Day yeas <br /> F- <br /> Q <br />' Z <br /> N 19 Hazardous Waste Report Management Method Codes(i.e.•codes to hazardous waste Vestment,disposal,and recycling systems) <br /> r ILU 1 2. 3. 4. <br /> r <br /> 20 Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manliest except as ndad in Item I8 <br /> Printedryped 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 /> _rll� <br />