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Please print or Type. t Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Erfergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST (=3"15a ) 0 1 1,7 7 5 JJ K CA c,B3�1 57=27 5.Generator's Name and Mang Address Generator's Site Address(if different than mailing address) C.AR,A,I100 TECHf11010C ti'E,S a �.3C.. '3&K fd HARRLS074 Vii. I'iCK-170H,CA .+ -:YjS Generator's Phone'r'es-rdfi 6.Tri ansporter 1 Company Name U.S.EPA ID Number F(rfAIDS Ef3'�'1F?�PclfriEfJ'fr+�sEf %i cS bri Cr?f iLtkfd7 y �'i 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Faellity Name and Site Address U.S.EPA ID Number 1315 SOUTVi RIVER ITI), PaPlf"�:r EF!'•A:%'P.:tf'Jfe)E':+J",N.L S'Ek?/1c;E.Cy iNC. G?,f�'Od:fltt��r VV7EST ACFs#-MI:IT[L),Citi 95,591 Facility's Phone:�lta-�'1"stir ga• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,tD Number, 10,Contai^ars 11.Total 12.Unit 13.Waste Codes HM and Packing Group(;I any)) No. Type Quantity WlNol. 1. Jt r$a 3'LCi1i� RI,LAI?L'1OUG W-AS;'t"E LvQUID.rRF.ALi!; SLI_iL GEl, Z43 `O Z 2. W LJ 3. 4. 14.Special Handling Instructions and Additional Information 9B-1);*-XJEIL&# t=FlGV4174 VI ' E.R. COPITRACTCrR: y+MiriS.EttTVJR6,%,f-cEf;iTAL " ;r '::� ''� IiAL117Lc ,�:�t9°sl C}BE iRr IP,tEC. 414jD ttSE EfoRG'lCCd J`^� , 'e f 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 labelediplacarded,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 EPAAcknowledgmenl of Consents I certify that the waste minimization statement Identified In 40 CFR 262.27(a)(d I em a large quantity generator)or(b)(iflyrrf sma quanb eratoo is true. Generetors/Offeroes Printed/Typed Name Signature i% / Month Day Year 16.International Shipments Import to U.S. Export from 13.S,f Port of entry/exit: ? Transporter signature(for exports only): — Date leaving U.S.: W 17,Transporter Acknowledgment of Receipt of Materials 4r, Transported Printed/ryped Name -^? Signature % r Month' Day Year X. z Transporter 2 PdntedrrTpg Nays Signature Month Da Year 4 Y tY i_� 18.Discrepancy 18a.Discrepancy Indication Space E] Qu.nti ly ❑Typo ❑Residue ❑Partial Rejectlon ❑Full Rejection ' Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S,EPA ID Number U FaciliVs Phone: F18c.Signature of Alternate Fadllty(or Generator) Manlh Day Year a z . S2 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) " C3 UJI 1• 2. 3. 4. 1-# ( °''B) y' 20.Designated Facility Owner or Operator:Certification of rece!pt at hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped(Name Signature Month Day Year e.r . ... ,. , ,r I I 10 1'>' l-! i EPA Farm 8700-22(Re 12-17) Previous edifions are obsolete._ DESIGNATED FACILITY COPY IF YOU RECEIVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e•MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE.