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Pfe ae ori,tor type.ran designed for use or,eliie(12-pitch)h,cewmer.) Form Approved.OMB No.205046039 UNIFORM HAZARDCUS 1.Generator ID Number 2.Page I of 3.Emergency Response Phone I4.Manifest TrackingNumber 9 f WASTE MANIFEST =��A,��f�'r�GJF:u -jr{?-�:iJ� 0089049,47 i 5.Generator--Name and Mailirg Address Generator's Site Address(a different than mailing address) C.ci;.rs -1csial .iaf�i _� x��'tirst:v .2n45 E `Irr'h -5- -,2435 E 'Jrrr! s &1antaca, C1 ;53L"3 klaniaca. L.A 3.;336 '11 Generator's Phone: JJ�dL4-4�]-35 6 Transporter 1 Company Name U.S.EPA.ID Number Heal``tlrnss Jarkas I 7 Transporter 2 Company Name U.S.EPA ID Number 8 Designated Facility Name and Site Address U.S.EPA ID Number Vadia ES Tachrual SdU:rs LLy 1125 Hars!--y St Richmond. CA 34841 Facility's Phone: 300-243-2382 9a 9b.U.S.DOT Descnption(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 Wl.Nol. o 1 UIN2511. Waste Toxic solids. WVariC, n.o.s. tT W.R2SCL} 3 i CF 75 P DOI1 ! D'024 311 Q rz w 2 UN I35C: -S-01S, pai,cln, 2.2 5.1}, y -- X J 'UN 1479. '+JltasCa.C dizinyl solid, n.xs. (Contains Sharr Mrat.e. P DOOM Du 11 551 X Pfxassium Nitrate), S.1 . If X 4UN2911, 'r`Jasra Toxic adids, Quark, n as (NICCTI'1E., � pool Polls 1311 WAt�PARIN), $,1 , 11 Dr- P -- k I 14.Speaal Handling Instructions and Additional Infomwtion7^C Dccuma�:: C22 r '1)993209 ER09154 1 x kval1 3) ERG#140 s IA 2)993715 E-RG#126 1X,S 54) 41199Z.212 ERG#154 Cx 15. GENERATOR'SIOFFEROR'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 IabeierUplacarded,and are in ail 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 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)(I I am a small quantity generator)is true. Genera�o s//eror's.nritediTyped Name Signature/ on ay Year 17 16.International Shipments ❑Import to ❑Export from U-S. Pat of entry!- Z Trans Date leavingU-S.- Transporter signature(for exports only): 17.Transporter Acknowledgment of Receipt of Materials LLJ � Transporter 1 Printed/Typed Nam gnature Month Day Year CL con Transporter 2 Printed ped Name Signati V Month Day ea tY F- 18.Discrepancy 18a Discrepancy Indication Space ❑ quantity El Type ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q �+ 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) UJI U) 3. / a J11qJ 20-Designated Faality Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed[Typed Name tt Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)