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DTS 104151 ON 2M? lllllifill�fllllil(llll[IIIIIIIII� <br />Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br />UNIFORM HAZARDOUS <br />'.Generator ID Number —F <br />7ge,3. <br />Emergency ResponsePhone <br />'S', <br />4. Manifest Tracking Number <br />0 012 3 2 0 61 VES <br />WASTE MANIFEST <br />C A L 0 ti 0 ti 1 r 4 S J <br />7; a, S-550 <br />5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />AT&T SER;-:uE DiRZC T T LLC <br />ATTN: RECORDS KEEPER 1 s 55 RBBC: TIP ST STF, 4 <br />1 AT&T WAY ROOM 1Al 11 C <br />Generator's Phone: 999 234-5013 EEDMINSTZR, Ni 0 -M1 -26Q--% SALINAS, CA 93901-4566 <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />'J`ECiLL�. ES TEGI�?IC�1 GC LUTTONS II J D 0 8 0 6 3 1 3 6 9 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />UIL.LkRO EidVTR.OTWENTAL. SERVICES C A D 9 8 2 5 3 4 3 3 <br />8. Designated Facility Name and Site AddressTIEOLIAES TECHNICAL SOLUTIONS, U.S. EPA ID Number <br />L.L.C. <br />1704 W. FIRST STREET <br />AZUSA, CA 91',02 �S A D l'I '3 a 3 j 2 9 0 3 <br />Facility's Phone: Sa "134 3117 <br />6 <br />ga <br />91b. 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 />WtJVol. <br />1 N01I-RCRA HAZARDOUS WASTE LIQUID, (SILICOTIES) <br />331 <br />0 <br />I <br />D F <br />9 <br />P <br />z <br />2. <br />w <br />0 <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information ER Service Contracted tQ VESTS + i; W:81737 AAZUDPK9 BID#172909-93 -335, <br />EMER#(800) 566-9347.1 EA 05I H2 FULL <br />15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: l hereby 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 EPAAcknowledgment of Consent. <br />certify that the waste minimization statawnt identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I a small quantity generator) is true. <br />Generator's/Offeror's PrintedlTyped N e_ Signatu Month Day Year <br />d <br />ON BEHALF OF AT �� /�A 77 �'.�� 0 314 1 11 7 <br />i— <br />16. International Shipments <br />❑ Import to U.S. Export from U.S. Part of entrylexit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />w <br />17. Tra iter Acknowledgment of Receipt of Materials <br />� <br />0 <br />Tr s iter Pr Oted/Type ame Signatu Month Day Year <br />/ <br />o -, <br />N <br />d e-4) / 4S d *� g-D 3 <br />Transporter Printed/Typed Name Signature Month Day Year <br />t- <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />181b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J_ <br />V <br />Facility's Phone: <br />W <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />a <br />Z <br />S2 <br />19. Hazardous W ste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />r <br />3. <br />4. <br />20. Designated Facility Wer or Operator. Certificatio f receipt of hazardg6s materials covered by the man' est except a _ in,.m 18a <br />Mamo � Si nature Y <br />17 1 TT <br />- <br />EPA Form 8700-22 (Rev. 3-05) Previous editions <br />obsolete. DESIGNATED FAC ITY TO DESTINAT O STATE (IF REQUI/RED) <br />12542.0875 <br />