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RECEIVED <br /> By Christine Lawrence at 2:22 pm, Oct 15, 2019 Form A roved.OMB No.2050-039 <br /> pP <br /> UNIFORM HAZARDOUS 1'Cie 7- 12- 1 of 3.Emergency Response Phone 4.Manifest Tgking Number <br /> WASTE MANIFEST i_ '. Ems" Q.s.Gam- '_ "' 'pS` I 34' 334-'2"i M; U�. ��.�� �6 J J K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> PACIFIC GAS&ELE-CTTRI � PG&E ElPH OT TA SUB <br /> PO BOX 7840 24350 E 1=L.Oi,D RD <br /> SAA FkANCSICO CA 9020 LINDEN CA 95326 <br /> Generator's Phone: 2 0 0 4 4 5 0 4 U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> PI-Iit.IF' WEST INDUSTRIAL SERVICES AI 0 0 0 � 6 0 � + <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> TR kNSF!DRMER TECHNOLOGIES <br /> 4709 TURNER RD SE <br /> SAI EM OR 97317 J 0 R a 0 0 0 0 2 6 7 1 <br /> Facility's Phone: +5CI3 354-1,14113 <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 9a. No. Type Quantity W001. <br /> HM and Packing Group(if any)) <br /> 1 NON RGRA HAZARDOUS OASTE,LI171UID(OIL FI f ED <br /> 3' <br /> oE1 PG's(?±r"dt,?..EO:!:PMcf'J•r;,r00PPi41 PCG) F� <br /> 0 0 3 <br /> UJ 2. <br /> LU - <br /> 3. <br /> ................. <br /> 14.Special Handling Instructions and Additional Informatlon <br /> NU45 .R 118-160 -��i; : - 7L1iv�+ <br /> JOE* <br />� 15. GENERATOR'SlOFFEROR'SCERTIFICATION: Thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> 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 <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 amia small quantity generator)is true. <br /> Generator'slOfferoes Printed/Typed Ime <br /> Sign tune Month Day Year <br /> , <br /> 16.International Ship ants El import to U.S. El Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLITransAWC6t&jinted1Typed Name Signature th Day ✓///Yea���r� <br /> a tMoyn/t)h . Year <br /> Z Transporter 2 Pdntedrr ed Name na Y <br /> s <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> J 3 � .( k:� <br /> l �., i i w c l (� Ma'fest 6eference Numbe. <br /> i tJ E `''` `� U.S.EPA ID Number <br /> �' 18b.Alterna a Facility(or Generator) <br /> i LL Facility's Phone: Month Day Year <br /> t w 18c.Signature of Alternate Facility(or Generator) <br /> f Z <br /> r S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. <br /> W 1 2. 3 <br /> C <br /> Y I <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Signature Month Day Year <br /> Printed(Typed Name <br /> ` LLL- ACILITYTO GENERATOR <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete.' DESIGNATED F <br /> I <br />