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Please print or type.(Form designed for usi:on elite(12-pitch)typewriter.)' Form Approved.OMB No.2050-0039 or ID Number 2.Pa Generator enerate 1 of 3.Emergency Phone 4.Manifest Tracking Number UNIFORM HAZARDOUS 1 / 9 enc Response 9 Y P � q 9�7 3aj j JJ KWASTE MANIFE 5.Generatoes Name and Mailing Address �eRit?Addrs,5(if different than mailing address) do• � F 1� 7 Generator'sPhone:/f J-; -, ��` ��a J ;1)AJ,/A19 R1F�SC3�GI % �/ ` 6.Transporter 1 Com'any Name U.S.EPA ID Number RANHOS 0�kflittj(Q tINC. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address - -•�.1 ,� ,.: U.S.EPA ID Number "AD Ell s PS SOUTH RVER RO. NES 60 ST 3ACF.Af,,1EPrr0,CA 9ff -I Facility's 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 Wt.N01. 1. itiL-r +, t":r.:•,^''. ! '�w.:' .iT' 't;:d `1NF+�S TE: it.i: �.i -III :.fj:ir.3iit:�I_S'Sf; `• j.i i f Z 2. Uj 3. I i ( 4. 1 14.S ecial Handling Instructions and Additional Information 1;r E€G91171 E.F. t:;014TRt CTOP: R,0AO�g ENVIFtC1IM-ENTAI. GEIFC,AGES fiAPj0LE- 3 '3Hf•ULD 13E TPAINED AND JJSE E?.PPPQN/FD Pptr. 15. GENERATOR'S/OFFEROR'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 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)(if I am a small quantity generator)is true. Generatoes/Offeroes Printed/Typerl,Name Signature Month Day Year -J 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.: w 17.Transporter Acknowledgment of Receipt of Materials � Transporter 1 PrinledfTyped Name Signature Month Day Year Z Transporter 2 Printed/Typed Name Signature Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V oFacility's Phone: Month Day Year W 18c.Signature of Alternate Facility(or Generator) Q Z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C31. PIt.( �, 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(ryped Name y Signature ) Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. Y/� DESIGNATED FACILITY'S COPY