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Please print or type. (Form designed far use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Pho77015895816 e 4, Manifest Tracking Number WASTE MANIFEST CA.L0l+3 10.,5+95 8444:24-241 016. 015 8 9 5 16 JJK 5. Generators Name and Mailing Address Generators SiteAddress (if differentthan mailing address) A.RAMA IK UNIFUFI1,rI MD C:A,REEF APPA•FEL LLC 70799 LONGE -ST Generators Phone:201P ^R3' -005 6. Transporter l Company Name U.S. EPA ID Number RHILIF r?uU-ST iNs?L»IRIAL S.ERGJBUE8 CAR000`i77527 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number ?=NE�r7ICAl. NbAS'YEp,4A.F��sCEt9.7€EI\I's INC CAi"IDtiPA4f3t : 7 35251 OLD MYLINE ROAD IKETTLEKAN, CA 9323'9 Facilltyds Phone: 2,00-222-2904 9a. 9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity WtJVOI. o NON RCRA, HAZAPDOUS ?ASE, SOLID z 2. g ) 3. 1 A. 14. Special Handling Instructions and Additional Information kik ,µ4 •3 - a,ij PROFILEOCA0081352 ` z1H yF4la3nSZ 15. GENERATOR'SIOFFEROWSCERTIFICATION: I hereby declare that the contents of this consignment are fullyand accurately described above by the proper shipping name, and are classified, packaged, marked and labeiedlpiacatded, and are In all respects in proper condition forbansport 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 EPAAcknowledgment of Consent, - I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) is two. Ge fors/ fferors Pantedrr ped Namq Month Day y Year -+ 16. International Shipments i-- ❑ Import to U.S. ❑ Export from U.S. Port of entry/e ' . Transportersignature (forexports only): Date leaving U.S.; o= 17. TranspoderAcknowledgment of Receipt of Materials w Transporter / Printed/Fyped Name Signal re Month Day Year '10k& oJ Y C? A)1nk& NSan1 Tmnspoder2 Printed/Typed Name Signature Month Day Year F q. 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑Type ❑ Residue ❑, Partial Rejection ❑ Full Rejection Manifest Reference Number: Ibe, Alternate Facility (or Generator) U.S. EPA ID Number J U LL Fadlity's Phone: w 18c. Signature ofAiternam Facility (or Generator) Month Day Year Q z y19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste Irea ment, disposal, and recycling systems) 3. 4. 20. Designated Facility Ownero Operator: Certification of receipt of ha rdous materials covered by the manifest except as noted in Item Um PriniedRyped Name I Signature MoNh Day Year II EPAForm 8700-22 (Rev. 3-05) Previous edltl s are obsolete. DE.StUNNAti ED FACILpTS7 TO DESTONATIIOM STATE (OF REZOl BED)