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02 <br />X <br />280148 <br />Please print or Woe. Form deal nod for use on elite 12 -pitch ewriter. <br />J <br />1155778 <br />FormApprioved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3 05) Pr6vious editidXare obsoleW. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />10748.0174 <br />UNIFORM HAZARDOUS 1. Generator ID Number. <br />2. Page t of <br />3. Emergency Response PhoneITO'CM403 <br />l a <br />JJ <br />WASTE MANIFEST 167732 <br />1 <br />800 424-9300 <br />5. Generator's Name and Mailing Address Generator's Site Address (If different than mailing address) <br />Pedes Prelght (Sn) <br />4521509" HIMAY 99 11OHlAGE ROAD 4521 SOM HIGHYAY 99 11011ACK ROAD <br />can2MCM CA 95215.UIM66-2127 Ism=CA 95215 12191466-2127 <br />6. Transporter 1 Company Name U,S. EPA ID Number , <br />2= C22ULW iffinggffin or. LIC 164012 <br />7.s iter 2 PName U.S. EPAJD Number 'Z+ <br />-. <br />8. Designated Facility Name and Ste Address U.S. EPA ID Number <br />GMM YAL ICY, LLC DHA PSC WiMMAL 311YIM <br />11855 MTM 1= ROAD <br />Facili s Phone: 183 <br />ga. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (If any)) <br />Quantity <br />WtNOI. <br />t' IOH-RC1A NAZAMIS YASYI LIQOID (PAINT) <br />331 <br />EF <br />z <br />2. <br />W <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />(1) IQ -11 - PRO 1811775886 <br />c e Ax r, lt, 2- <br />15. GENERATWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment ent are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />15. <br />marked and labelediplacarded, 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 <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 gen rator) is true. <br />GeMaW#Oftroes Printet/T Nam / Signature Month Day %Y <br />-a <br />I= <br />16. Intemational Shi entsc <br />❑ import to U.S. ❑ Export from U.. ort of entrylexit <br />= <br />Transporter signature (for exports only): Date leaving U.S.: <br />W <br />17. Transpo terAcknowiedgment of Receipt of Materials <br />OTransporter <br />1 'nted/Typed Name Signature � Month®� Day 78'er <br />a <br />o + - tt`t6 CN ` <br />QTransporter <br />2 PdntedlTyped Name y Signature Month Day Year <br />C7 <br />18. Discrepancy <br />18a. Discrepancy Indication Space Ef Quantity ❑ Type Residue ❑ Partial Remotionej <br />Full Rejection <br />Manifest Reference Number. <br />18b. ARemate Facility (or Generator) U.S. EPA ID Number <br />v <br />Facipty's Phone:. <br />W <br />18c. Signature of Ahemate Facility (o Generator) <br />Moretn y Year <br />2 <br />y19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />t. <br />2. <br />3. <br />4. <br />� <br />20. Designated Facility Owner or Operator. CeMeat(on of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/ryped Nae <br />nature <br />jLI-&A <br />Month Vear <br />EPA Form 8700-22 (Rev. 3 05) Pr6vious editidXare obsoleW. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />10748.0174 <br />