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�:F''-'� .. ;�: Please print or type. � s �-.�r� Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS WASTE 1. Generator ID Number 2. -Page 1 of 3: Emetgency Response Phone 4. Mggan��ifestTracki�9ng Number V � � �A � � F L E MANIFEST G�iL�,15�� .I „��ry,�2 s 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) iiU�I�ti ia�ift�( � 1 'i �1i124'1tt�iitt:l' �� �.cxlf, CA 95240 Generator's Phone: 6. Transporter 1 Company Name U.S. EPA ID Number f1d1�1iC� �i'iP.f'Y11Ce'if t"�F�YiS�IOi'� it1C.��A f1�:�Ei�IRC.? 1 i �(.�+� . 7. Transporter 2 Company Name U.S. EPA ID Number UIlcridvvlda �eco>�y Syst�n, Inc �,.�i�(1?�� ;�� 8. Designated Facil(ty Name and Site Address � ed i � �� U.S. EPA ID Number �`t�ma YES, LE.� 2730 E. 9 3tt a St �a �. `' I tZ� [� i11 l: �d 1f f® C;1-! L �1 l�'C t � C1C305'� 5t��4 �' Facility's Phone: �z�^�-��+� ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol. � 1�1Vf�n-1�t;�A I�a.zaede�us 1hJast� �oiic� (CFai �ilt�ra� t , fes, � �2� o � �`6 '�" z. w t9 - 3. 4. 14. Special Handling Instruc8ons and AddiBonal Information : �FOg��$ i�i1t711;3EF �Q� l.1frCUt't's�?�i �: D�S��fi ;;:..._ >. ,_.. - .. . ,r - j� _ :r;�s�' r '�" f�� r C ,r' 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the centents of this consignment are fully and accurately described above by the proper shipping name, aryl are classified, packaged, marked and labeled/placarded, and are in all respects in proper cendi8on for transport according to applicable international and national governmental regulations. If exporfshipment and I am the Primary Exporter, i certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a small quantity generator) is true. Generator's/Offeror's Printed/Typed Name Signature ,,-� Month Day Y r � � 16. Intema6onal Shipments � ❑ Import to U.S. ❑Export from U.S. � Port of entrylexit: ? Transporter signature (for exports only): Date leaving U.S.: � 17. TransporterAcknowledgment of Receipt of Materials q i � a T ns er 1 Pri d yped a ��/�*� Si ate r-- Mon�h Day �r �� r r ��° �d 7�.� ". tf�� 5r •^�i,°�+i��_ � � �d�dNN�A'' fj¢ ��' r�i z Tran�✓sporter 2 Printed/Typed Name ,,.-•--- ,---- Signafdre /"� � ; � 1 Month Day Year t'S.._ � '��r��•,�' i •/.._ 1� �.__ � ..,-..�.�.�'�'"'`� �C� � t �1 /,i.� ';:{i'/':l'.tr Cl � j � 4� r` - � ,//'I 1�'� ../r 18. Discrepancy p 18a. Discrepancy Indica8on Space r ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑ Fuli Rejection Manifest Reference Number: H 18b. Ntemate Facility (or Generator) U.S. EPA ID Number J_ V Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) w 1 2. 3. . � � i �L.i �` � 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Month Day Yearp Signature/,fyJj /' f rr{�- ^I ii r i{ 1} ( �) �� [+ � t. lr'• !r ��1 � r f � r( �_ �l � 1 A 1 :i,. i...� '" I 1 i .i� '{'f i .� ; /I1. EPA Form 8700-22 (Rev. 12-17) Previous`editioris�are o so ete. f `� `{ `-a DESIGNATED FACILITY TG GENERAT®R