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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2: Page 1a' <br /> 3. Emergency Response Phone 4, Manifest Tracking Number ppm <br /> WASTE MANIFEST CALL100 065!9 t 844—aM—'3408 015895817 J UK <br /> S. Generators Name and Mailing Address - Generators Site Address (if different than mailing address) <br /> IARAMA K LINI FORM AJ%JD CAREER A;PPMEL LLC <br /> 7079 LONGE ST <br /> TPUC°PC3N, CA: 96200 <br /> Generator's Phone 209-23441105 <br /> 6. Transporter i Company Name U.S. EPA ID Number <br /> P��O®� �� 'ltd <br /> PHILIP WESTINDL1STRIALSERVItCES �r <br /> 7. Transpoder2 Company Name - U.S. EPA ]D umber <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHE�,<fC�✓�E lht��§S'€ Ef�aL�4i:��-E�;iE4�SF6 �9G CAY1300040117 <br /> 35259 QLD SKYLINE ROAD <br /> 1 E;LEMAN, CA 9323-9 <br /> Facility's Phone: BOM22-M4 <br /> ga Ob. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, . 10. Containers 11. Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity wt./Vol. <br /> t <br /> 0 1. NON I CRA HAZARDOUS WASTE, SOLID Y 0 42 —� <br /> w )' <br /> 4. <br /> k _ t _ <br /> II <br /> 1 <br /> n <br /> 14. Special Handling Instruct ons and Additional Information <br /> w„ <br /> ' 2�r <br /> PRCPPLECA�dd88 2 � Z <br /> w �iy 3 y <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION: I hereby declare that the contents ofthisconsignmm! tNly and accumlelydescdzbed above by the proper shipping name, and are classified, packaged, <br /> marked and latmedlplacarded, and are In all respects In proper condition for transpod according to applicable International and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I cedily that the contents of this consignment conform to the terms of the attached EPAAcm"=dgment of Consent. <br /> I cedily that the waste minimization statement Identified in 40 CFR 282,27(a) (if l am a large quantity generator) or (b) (If I am a small quantity gen for) is We. <br /> GerimatoeslO more Prin eq, 'ed a ' e., Signature with Day Year <br /> b" I` <br /> J 16, International Shipments <br /> F Import to U.S. ❑ Export from U.S. Pad of enirylexil: <br /> Transporter signature (for exports only): Date leaving U S&: <br /> 1Z 17, TmnspoderAcknowledgmentof Receipt of Mated als <br /> w <br /> Transporter Printed/Typed Name Signature Month Day Year i <br /> 0 �7 117 <br /> Transpoder2 Pnntedlfyped Name Signature Month Day Year <br /> P- <br /> !I 18, Discrepancy <br /> I 18a. Discrepancy Indicator Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection _ ❑ Full Rejection <br /> Manifest Reference Number: <br /> 181h. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> V <br /> I< Facifty's Phone: <br /> 18c. Signature ofAlfernam Facility (or Generator) - Month Day Year <br /> a <br /> Z <br /> N19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1, 2. 3. 4. <br /> 20. Designated Facility Ovmmor Operator: Cerbification of romipt of hazafdous mater als covemd by the manifest except as rated In Item 18a <br /> Pdnted/Ty ed Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FAC Bp ITV T® DESTINATION STATE (OF RE'QU9PIC <br />