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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved'. OMB No. 2050-0039 If Generator ID Nu b r 2 Page i of 3. Emergency Respon e Ph ne 4 M nif st Tr cking Number UNIFORM HAZARDOUS .x r r ii F.` } WASTE MANIFEST li E,., i "'c t„a P JJ K 5. Generators Name and Mailing Address Generators SteAddrs (if different than mailing address) 7 acylJrIIIod 4- hoof D1C11i t Tr halii h . chca! 1675 'VVLam, HPo� 3i5EcsF19t1IS€ - - - Tce cy, CA Tmg4 CA' S 7 ; Generators Phone: 209-32i - a ""� - 6. Transporter iCompany Name U.S. EPA ID Number - q - nllsre {o 2Cerr,r-lib)(` CFiPHONE-Gu tID'V7E6000 ,,") GAR000179O747 7. Transporter 2 Company Name U.S. EPA ID Number Clem Ii EDViITlnnlfnief Scr Vbss `AAD039322250 8. DeslIgppafed Facility Name aria Sile Address U.S. EPA ID Number gmelefi Yi FFT:Si `.1an Jose , LL(: 9021 Rarryessra RoadGFS 059x943 i0 Sort Jose , CAR5133 Facility's Phone: 4.013 41 -095.- 9a, 91h. 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 WINO). f' r,e,tr Llpfc, tSpe- c, „ cns In Fo rn . lrin) z 2. 4. 77frT I 14. Special Handling Insmrctions and Additional Information Docurt e r:t D41468 Sales Omc 60743 - - I )Ptrtflfs� " I-; 1016561 D01—E`'.G; 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 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 minimization statement identified in 40 CFR 26227(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is Ime. GeneratorslOfferors Printed/Typed Name Signature, Month Day Year i ri 16. international Shipments P— ❑ Impod to U.S. ❑ Expodhom U.S. Port of entry/exit: Z -Transporter signature (for exports only): Date leaving U.S.: - w -17. Transporter Acknowledgment of Receipt of Materials _ Transporter 1 Printedffyped Name. I C Signature Month Day Year o G� Z Transpode[ 2P nledfrypeed Nama""- { //"" / - Signature,.•a` �-- Month Day Year 18. Discrepancy l 18a. Discrepancy Indication Space ❑ Quantity El Type Residue Partial Rejection Full Rejection Manifest Reference Number: i8b. Alternate Facility (or Generator) U.S. EPA ID Number ua- Faciliys Phone: 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z L19. azardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 4. 20. Designgted Facility Owner or Operator Cedifcation of receipt of hazardous materials covered by the manifest excepta. nded in Item 18a Pnnte yped Name.- f � i Signature / ! Month D/�(,�' . Yea EPA Form 8700-22 ft3-05j Previous editions are obsolete. �� DESIGNATED FACILITY.TO GENERATOR `