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Please print or type. (Form designed for use on elite (12•pitch) typewrite r. i . Generator ID Number �o Form Approved, OMB No. 2050,-0039 UNIFORM HAZARDOUS L fit` `Z + �y 2. Page 1 of 3. Emergency Response Plane 4, ManUest Traakin Number WASTE MANIFEST Soo $ • 4 & 7L 0152 9782 JJ K 00, 5. GenaratotaNameandMalifngAddress ` G nerators5lteAddress ifdifferent than maili address CAST SAY MVP Ar+F: p �1RDRar Al6VAC BAST BaY Mt1 � � ) P.0, 1roX2406 .13 , +45 7ot Z57 , '2, IAS► M , PL (I ad bArKLAiV0jo CA 94623 >J,v� nes c ,9 Generator's Phone: 510 -2 8 7 - 155 � 6. Transporter i Company Name U.S, EPA ID Number C GA Vt " AIM S TA Lia S KV1ce= s N CWCARpaoo 3dtt 7. Transporter2 Company Name U.S. EPA ID Number i 8. Designated Facility Name and SiteAddress U.S. EPA ID Number CNdsBY & OOVC' NTOAI INC . 16 345 w « t!, STtk lac LOAF& BEACH , ,CA gogr3 Facll( s Phone: g — 'q• 32 -- 61111146 Apo 2 & ocl b t 9a. 9b. U.S. DOT Description precluding Proper Shipping Name, Hazard Class, ID Number, 10. Containers HM and Packing Group (if any)) 11. Total 12, Unit 13, Waste Codes 1 N 077 WA PAfZA%Nb0DS WN3"T" No. type Quantity wtNoi. � , Sod! D, N.v*, {MST 4 S NAV I V& 47Y 111 C � D cao? w 0- D 1 1 ) F O D 60 LLIz oN - R6A 1AAZO Ajkpays WASTE, Ilavto, Militia ( u �Ep 61L ) 3. ON- cRA '� � RDovS 11I�5T6, Solt DN1 0140 `OILY - 4 o D l VF ® 020 35Z 14. Special Handling instructions and Additional Information �y 3&1 b. � 2876b � txt� qb_ 2) 3375 tivi 'S DM) ab , 3) 332 ©o / (Ixs F 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, marked and labeled/placarded, 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent I certify that the waste m(nlmization statement Identified In 40 CFR 282.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) Is true. Generato stOfferot s Printed/Typed Name , Signature Month Day Year —r 16, International Shipments Z ❑ Import to U.S. ❑ Export from U. Port of entrylexll: Transporter signature (for exports only): Date leaving U.S.: W 17. atedal TranspoderAcknowledgmentofReceiptofMs Transporter 1 Printed/Typed Name Signature Month Day Year rans o erg Pdate e T "� ~� 2- 1 p dflyped Name Signature Month Day Year 18. Discrepancy I III NEW Will 11 MEMO 18a. Discrepancy Indication Space OEM 0quantity ❑ Type YP ❑ Residue ❑ Partial Rejection ❑ Full Rejection 10 W. Alternate Facility (or Generator) Manifest Reference Number: ,j U.S. EPA ID Number V LL Facility's Phone: 18a Signature ofAiernate Facility (or Generator) Miinth - OOOOO Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e.. codes for hkardous waste treatment, disposal, and recycling systems) Uj G] 1 20 3 4 .0. Designated Facility Owner (" Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a Print /Typed Name signature Month Day Year EPA Form 8700.22 (Rev. 30,05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)