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Please print or type. (Form designed for'use on elite {12 -pitch} typewriter.) Fnrm Annrnved (]MR Nn 9nRn-nnaa
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<br />1. Generator ID Number
<br />UNIFORM HAZARDOUS
<br />2. Pae t of
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<br />3. Emergency Res posse Phone 4. Manifest Tracking Number
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<br />WASTE MANIFEST CALM'S .37' ,i ,i
<br />11)S7
<br />-g7 -7
<br />{ J r t''.( 69 008548504 F L E
<br />5. Generator's Name and Mailing Address (jenerator's Site Address (if different than mailing address)
<br />D131!'1' r3crfer.'l (217632 Oollar Generati13632
<br />209aPS394/1 2907 E. PATERL00 RIBIRD c'r@7 C. UATEIRLOD ROM)
<br />Generator's Phone. STOUJOiL Cn X5='05-292, I STOCRTON. CA 95205-P92A
<br />5. rsmpoftr 1 company Name U.S. EPA ID Number
<br />Sfericvelf 5flrtiolLil NoCA-c SUIU`inrir Inc I Frhs!iGE �tifR924
<br />7. Transporter 2 Company Name U.S. EPA ID Number
<br />B. Designated Facility Nam/ e end Site Address S e n e r a l E n l i r o n u t n t a 1 t4q z, LLC U.S. EPA ID Number
<br />11853 White Rack Road
<br />Rancho Cardawi, CA 95742
<br />Padlit rs Phone: rJ 1 -,"�__.5 1 fs,98C I f 17T1e'A lAl�w i A
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<br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
<br />10. Containers
<br />11. Total
<br />12 Unit
<br />13. Waste Codes
<br />No.
<br />Type
<br />HM
<br />and Pecking Group (if any))
<br />Quantity
<br />Wt Nott
<br />1' UN1993, LJc�s;;c Flaofrat,le liquids n.u.:;.
<br />I
<br />D;=1
<br />0"M,
<br />P
<br />:;3
<br />D7131
<br />(Alcohol), 3, F& lI, FRU128
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<br />LU
<br />;.2
<br />U,,43 13% H -a -,`o 01;idi-inn liquid, n.o...
<br />1
<br />17
<br />00272
<br />P
<br />14
<br />DOG!
<br />(1-lydroyen peruxidf,); 5.1, PG II, ER154,41;0
<br />3 fLRu,Lj tblt 2.1, FREOI21
<br />1
<br />UJ=
<br />05,36,
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<br />33.
<br />Da -MI
<br />4 Con.uwet' Electrcnicc fair Rec�,rling E-
<br />2
<br />CF
<br />013x1:
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<br />18:
<br />0-tsra e7,
<br />14. Special Handling Instructions and Additional Information 1. 1 F ! a.-: an n fi l I t Lx x A ,,t i U,,; - �_ 1 U ; r! 1 c'C Gr ? �, 1 T 0525 (0 x i d i z e t•" 7 ;
<br />f_igt.fid — i-witepock) 3. 110'53.1(Pvuso15) 4.EleCt.-'On1C= for Rocycl?nP)
<br />15, GENERATOR'SIOFFEROWS CERnFICATION: i haraby derJare 1ha1 the samrxtts W rila oomelg<vnent ora icty and aauralely desoibed ebara by the proper Shipp rg name. artC are dassiked, packaged,
<br />marked and IabeleWplacarded, and ora In all rewect5 in prppercondit m for transport amoairrg to applicable international and national govemmerrtai regulaliam. If export shipment and t am the Primary
<br />Exporter, I certify Ibal Ire conterrlss d this conslg'trnem conform to the IWM of the attKW EPAAclunwledpwi of cortserr
<br />I oer* OW tw%7sie rnhimiralion statement ided-W in 40 CFR 26227(5) ('d i am a Large gwaty tgenetaV) or (b) @j a a smaN quantity generator} is true.
<br />nwato ntedrr Name Signature rnomn Day rear
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<br />16 Int mationat $hipmen ❑ /� 0' "
<br />Import to U.S. ❑ Export lrekrU.S. � Port d entrylexit:
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<br />Transporter signature (for exports only): Date leaving U.S
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<br />17. Transporter Acknowledgment of Receipt of Materials
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<br />Transporter 1Printed) IypedName 5 month 08y Year
<br />J: r' ;lZ, ciul I oil id Pn;
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<br />4
<br />Transporter 2 Pnnted/Typed Name bignature _ — Month ay ear
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<br />1,)✓t IVl. hA�,�I,7r w I I I I0q If -
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<br />16. DiMpancy J f
<br />t8a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection
<br />Manifest Reference Number:
<br />18b. Alternate Facility (or Generator) U S. EPA 10 Number
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<br />Facility s Phone:
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<br />18c. Signature of Alternate Facility (or Generator) Month Day Year
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<br />k I I
<br />19, Hazardous Waste Report Management Method Codes (i.e..,, codes for hazardous waste treatment, disposal, and recycling systems)
<br />C11I2
<br />R 141
<br />3 141
<br />1
<br />I4 /1 1
<br />20. Designated Facility Owner or Operato�ertification of receipt of hazardous materials covered by the manifest except as noted in Item 18a ; ,I
<br />Printed/Typed Name Signature f Month Day Year
<br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DZSIG,! i ED F A&ITY TO GENIERATOR STATE (IF REQUIRED)
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