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Vw� X14 Please printer type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 4 UNIFORM HAZARDOUS i Generator ID Number 2. Page i of 3. Emergency Response Phone 14. Manifest Tr ck ng Number p �( WASTE MANIFEST Lz 1(I int E �6 f E- I v` �i 3 JJK 5 Generators Name and Mailing Address > ' . ` — Generators Site Addres (lf different than mailing address) II cy lnrEdbCiIVNtlLLViet Ir krIlipLS Co! 875 VV l_oh ,.fl /uw 3 fv LIDS I Cth-St acy, CPAFraCy, CA 9537 6 _ 203-32i -3S.?_v - Generator's Phone: 6. Transporter 1 Company Name U.S. EPA ID Number IITer�niutn `" ERIFLr}dE-CostIDtBrEG-00'04.^"" ) I UvQ0001, 797+7 7. Tra poder 2 �gmpany Name U.S. EPA ID Number Z,Icen FlrbQts Lnv$ronitiental SeeticfjG 0039322250 8. D ienated fgqcllName anVite Address - - - - - - U.S. BRAID Number 1Asoa 11'a6ityE ]'.X G nEtysODliv, LLI. - 15300 ttOi'hl N)tus Rotad iJTD:?815J21Tr Granl=Oltff, UT 84029 X35-684 -8 'i C10 Faciliys Phone: 9a 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 WtJV01. i U \12. j !' ytr - . r: ISc F tai a t^`:, L, , !I rc 1 DQ:i i 2. Uto62� 1 'DstG SadEtmm Ifo ft'1 = sc4letiQii, R. , II - 7, . . . -5E1 � D032 >: 'c>` 0 3 55'i D005 � JF`3f1Bi "f rrcto¢I �, SfE , (Iqula , l (Fatillm ), 9 , III 4 14on-RCRN, i i rardQus UVastc Liquid (Ceztcluin Chloride, 551 I PD�SSIuI;cQhlOdCi�) �� 14. Special Handling Instructions and Additional Information _ DocOTTE-nt D41467 Safes Omer 30743 I )ProfilQ%o153G i DCT L PG T' 12E� 1 R-1 1 LCGRf_i / 5C' H2 )PI'Ofi 0153Cs i DOST CRCy i 1 TR-3%I / LCC. kC / 5C K2 '' )PeofiienAf »Ci DOTCRG', i a? n-`s-21I_CCRf315C H2 )Pri1tc4, 15351 DOT ERC~; TI - + 1 LO CRC t 5G tie: 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 l 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 statementidentified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Generatorsl0fferors Printedryped Name Signature-: - Month Da//y Year 1 ! 17 1t � >`l, ! [ c:. . �.Z � �r-cis �- L --1 16. International Shipments F ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: Z Transporter signature (for exports only): Date leaving U.S.: 17. TfanspoderAcknowledgment of Recent ofMaterials - - �L, Transformer 1 Printedlryped Namel--- jSignature /"'j am`"% Month Day Yearf. Z Trie sporter 2 ri tedlryped Name l F' - Signature �.' - �/ Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity El Type 11 Residue ❑ Partial Rejection ❑ Full Rejection - Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U Facility's Phone: w Tic. Signature of Alternate Facility (or Generator) Month Day Year C z _- -_ . _ . — _ . . . . _ .. _ .. _ . ._. . _ . .._ - .. -- - _ 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) d. t 2. � d`-1V 3. 4 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item lea , PrinledfTyped Name Signature 1 Month Day Year it EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR