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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved, OMB No. 2050-0039 ', UNIFORM HAZARDOUS 1 1. Generator ID Number2, Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number p p,� WASTE MANIFEST d. A 1 @ O D 9. f] 5 � � � `! $1-3® t 2a- Vgf1f ® d1 118 ® 9,12 JJ 6'k.. 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) A RANIARK 7679 S. LONGE ST. S T C Ch i CtN C'A 95206 Generalars Phone: f 20961234- 01105 '... 6. Tr spo eel Company Nam Rq ` er U.S. EPA ID Number Tr wegr 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number '. CHEM! CAL tlVAZUE MA1Y1AG EF"SENT, INC, 5251 OLD S VLINE ROAD C A T 0 0 0 0 4 5 1 1 7 KE T TLEvBAN CITY CA 932.9 Facility's Phone: m- 9Z I I ` Saw 91h. U.S. DOT Descriptian (Including Proper Shipping Name, Hazard Class, 10 Number, 10. Containers 11. Total 12. Unit and Packing Group If an Ouanfi WINol. 13. Waste Codes HM 9 P ( Y)) No. Type lY ti oc NODI RCRA HAZ1tiFDOLIS WASTE SOLIDI CA608852 w 2• :+ - .�Jr -- 3. ! 4. 14. Special Handling lnstruciions and Additional Information 1 • CA1508852 CHEtVITREC CON I RACT # CON24117 15, GENERA70R'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignmentare fully and aceurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and tooth all respects In proper condition for transport according to applicable international and national governmental regulations. if expod shipment and l am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmanl of Consent. I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quanetygenerator) or (b) (if I am a small quantity generator) is two. Gene Isl Item a rinted/TypedNarea Signal Monty E04 LWar J 16. Intemational Shipments r— ❑ Impod to U.S. ❑ Expodfrom US. Part of entry/exit: Towsportersignature (for exports only): Date leaving U.S.: w17. TranspoderAcknowledgment of Receipt of Materials P Trons der 1 Pis rfyted Nae SIg are Month Day Year 0 QTransporter 2 Plintedflyped Name SgraturrV V Month Day Year 18. Discrepancy _ 18a. Discrepancy Indication Space ❑ Ouan0ty ❑ Type .❑Residue J j ❑ Pallial Rejection Full Reaction Manifest Reference Number: 181h. Alternate Facility (or Generator) - U.S. EPA ID Number J U roc. Facility's Phone: w 18c. Signature ofNtemate Facility (or Generator) Month Day Year z 19. Hazardous Waste Report Management Melhod Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. 2. `>Z 20. Designated Facility Owner or Operator: Cedification of recelpt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year I (nS 12 t EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete, DESIGNATED FACT LIT 1' TO DEST11NATION STATE (IE REQUIRED)