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ease print or type. (Form designed for use on elite (12 -pit UNIFORM HAZARDOUS 1 1. Generator ID Number WASTE MANIFEST I MOON it 5. Generatoe's and MoT' Address �tl AST Y ;;VD T.O. )( 2405S S >04 OWLAND CA, 946 -Vi, r erates Phone:1 iC 2.87— a ans bred 1 Companay jName lV IM HM , t n. •T.. — a Form Approved. OMB No. 2050-0039 2. Page 1 of 3. 6-0 Response It(67 2 4 0152732201 ss Site Addresspf, di�ent than mailing address) C E 5� r t 2 2 P'E KD' ® "7 U.S. EPA ID Number A 0000 3011 U.S. EPA ID Number U.S. EPA ID Number l - ! w —a e9 t . —e% �—TO �1 Pi'uusFZrLt 3Lt6cs(. 3 24s? 4 i 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of Oft consignment are fully and accurately described above by the proper shipping name, and are classIM, ed, marked and labeleddptacarded, and are in all respects in proper condition for transport accordIng to applicable International and national governmental regulations. N export shipment and I am the Primary Exporter. I certify that the contents of this consignment conform to the terms of the attached EPAAcknow1e#wt of I certify that the waste minimization statement identified in 40 CFR 262.27(a) (d l am a large quantity generator) or (b) ('Ill am a small quantity generstorl is true. it tI Import to U.S. U Export from U.S. Port of entrylexdt ----------------- Transporter signature (far exports only): Data leaving U.S.: LU 17 T r eit of Receipt of Materrals y 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑Type Residue 'a. Manifest Reference Nun 18b. fie a. to Facility (or Generator) - LL Facfiity's Phone: AUG 22016 10 98c Signature of Alternate F;—* (or to) 19. Hazardous Waste Repot Management Method Codas (i.e., tis for waste treabnent disposal, and recydNg sys s) ®1 2. 3. 20. Designated Facfiity Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in (tern 18a Printedfi Norrie Signature EPA Form 8700-22 (Rev. 3.051 Previous editions are obsolete ❑ Partial Rejection U.S_ EPA ID Number B is A DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) .bU.S.DOT Description...P.._ .. s and Pacidng Group (if any)) rr � � �' iii � Ica ♦; �—TO �1 Pi'uusFZrLt 3Lt6cs(. 3 24s? 4 i 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of Oft consignment are fully and accurately described above by the proper shipping name, and are classIM, ed, marked and labeleddptacarded, and are in all respects in proper condition for transport accordIng to applicable International and national governmental regulations. N export shipment and I am the Primary Exporter. I certify that the contents of this consignment conform to the terms of the attached EPAAcknow1e#wt of I certify that the waste minimization statement identified in 40 CFR 262.27(a) (d l am a large quantity generator) or (b) ('Ill am a small quantity generstorl is true. it tI Import to U.S. U Export from U.S. Port of entrylexdt ----------------- Transporter signature (far exports only): Data leaving U.S.: LU 17 T r eit of Receipt of Materrals y 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑Type Residue 'a. Manifest Reference Nun 18b. fie a. to Facility (or Generator) - LL Facfiity's Phone: AUG 22016 10 98c Signature of Alternate F;—* (or to) 19. Hazardous Waste Repot Management Method Codas (i.e., tis for waste treabnent disposal, and recydNg sys s) ®1 2. 3. 20. Designated Facfiity Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in (tern 18a Printedfi Norrie Signature EPA Form 8700-22 (Rev. 3.051 Previous editions are obsolete ❑ Partial Rejection U.S_ EPA ID Number B is A DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)