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Please print or type. _ Form Approved.OMB No.205W39 <br /> UNIFORM HAZARDOUS '1.Generator ID Number •2.Pae 1 of er�gjency Reusponse Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST Iy33 T l g�8 l l 9yd li 020427507 JJ K <br /> 5.�enerasnd MalidregS�f +�I9 CGLGenerators S;te Address('rf d cerent than mating address) <br /> �z l '�pX? S <br /> Genera__tporqq's Phone: yy8�b-VP71 <br /> pR1`�1in � �p �Q urn <br /> 6.tRstr fARCR1QLOfg S.IRC. Cs 1+1A1{Nil� 0 2 1 7 5 1 3 <br /> 7.Transporter 2 Company Name `U.S.EPA ID Number <br /> 1 <br /> 8.I� 4ar� d Site Address U.S.EPA ID Number <br /> 410 W.A or&Avenue <br /> f BboMkliffiDt CA 92316 <br /> Facility's Phone: SW 4211-2M2 C A D 9 8 2 4 4 4 4 8 1 <br /> 1ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 1 .HM and Packing Group(if any)) No. Type Quantity WLN01. <br /> 1 /v G�?•� l t 1 SS( <br /> Uj <br /> 2. dr, ' <br /> 3. <br /> 4. <br /> 1�pecial Handling Ins ons��nndd Additional Information �—� <br /> ! /4A-L L pSL.L—L7Z �l J c� 6Y//C� <br /> 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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If export shipmentand I am the Primary <br /> Exporter,I cergfy that the contents of this consignment conform t0 the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator or(b)(ill am a small quantity generator)is true. <br /> Generator's/011amr's PrintedfTyped Name Signa Month Year <br /> 16.International Shipments <br /> F. ❑Import to U.S. ❑Expq�Sm U.S. Port lexiti _ <br /> ? Transporter signature for exports o Date leaving U.S.: <br /> W ix17.TransporterAcknowledgmentofReceipt ofMaterials <br /> Transporteril Pr�tedlTyped, e. �� Signature _ Month Daffy Year <br /> LVO fc17 1 <br /> Z Transporter 2 PrintedlTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space F� Quantity, 0 Type ❑Residue ❑Partial Rsoon ❑Fug Rejection <br /> Manifest Reference N <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> ..r <br /> V I <br /> Facl s Phone: <br /> W 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20,Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />