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Please pent or type, Form Approved.OMB No.2050-0039 FjUNIFORMHAZARDOILIS 1 Ganeralor ID Number 2.Page 1 of 3.Emmnency Response Phone 4,Manifest Tracking Number EST � �� T 71 1 ;V �tfd 0 2 0427507 JJK and Mali dra Generators 51teAddress(if different Ihan mailinaddmss) ��61 scd�,Tr,4 C e,� eZ6.41 04, zs3�' /330 -res: Generator's PGe; t b'�r'o—rev a SFJRC1 �, 2 J YD 6. nspgrternComp-agy l l�S F� yin y ��1! !'1�d! pgiwC5, tlls:- 7.Transpoaor 2 Company Name U.S.EPA ID Number 8.�"f fjMjand Site Address U-S.EPA ID Number ISO W.Wirdo ArOIlI* BIMM rVbn CA 92316 Factlily's Phone: 9W 421'=2 C A D 9 8 2 4 4 4 4 8 9 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any))�} No. Type Quantity Wt.Nol11.Total 12. t 13.Waste Codes 1. 21 O1 lovao 12 C 24 14_+21f--R_0&5 AshSZc 3� CABs �� S} �' d bs 3. 4. 14.Special Handling 1nsVu lions Additional Inrarmalion A- L�P�LL-d Z C��d� �� 0-7 z} N�S 1 D �, .�6,f, �Ss� 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 intemational and national governmental regulations.If export shipment and t 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 282.27(a)(if I am a large quantity generator orb (if am a small quantity( )( q ty generator)is true. Generator's10Berer's PrinladlTyped Name Signa Month Day Year P .V- e ---� .5 '� f Zo af Shipm1= ❑Import to U.S. ❑E a m U.S. Port t lsxil- Znature(fryDate leaving U-S.: OXransransAcknowledgmenttt000f Receipt of Materials, � fla ,j -�� Month /Day Year Transporter 2 PrintedfFyped Name ` b Signature 17 Month Day Year F 18.Discrepancy 1 Ba.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection F 18b.Alternate Facility(or Generator) Manifest Reference Number. EPA ID Number L) LL Fa0ly's Phone: w 1R.Signature 07Allernale Facif ty(or Generator) Q Month Day Year Z W19.Hazardous Waste Rnport Management Method Codes(i.e-,codes for hazardous waste treatment,disposal,and recycling systems) D 1 12. 3, 4- 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrfyped Name Signalure Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM