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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 1. Generator ID Number 2. Pa e 1 of 3. Emergency Response Phone 4. Manlfeat Tracking Number p p� <br /> WASTE MANIFEST Clk�..030L SC1 �- iii t�. —3°•r_`�+fgtE=$ 01 g g ® 5 �! N) tt� <br /> 5. Generator's Name and Malting Address Generators Site Address (if differentthan mailing address) <br /> P�°+7AI UNIFORM IFORM APCs CAREER-. A€P}', PE1 LLC <br /> 71379 LONGE ST <br /> STOCK T ON, CA 95206 <br /> Generators Phcau:259'22-% -8105 <br /> 6. Transporter 1 Company Name U.S. EPA ID Num <br /> PHILIP 'sfv�S'T INDUSTRIAL SERVICES (14 -9101 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Faclllty Name and Site Address -C . EPA ID Number <br /> !-iEFiNI CAL `�Afr4S WASTE k44A4��+aEPt>'IECdT INCI t�;tC Cf05'6901I <br /> 35251 OLD SKYLINE ROAD <br /> KETTLEMAN, CIA 93239 <br /> Facility's Phone: 800-222-29@4 <br /> go. 91s. 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.Nol. <br /> o NION RCRA HA74RDOUSWASTE, SOLID / C14 �$] Y ___449R __� <br /> ra— <br /> K I I <br /> Z. <br /> 3. <br /> Y <br /> 4. <br /> 14. Special Handling Instructions and Additional Information <br /> PROR LE 4 C:A608652 <br /> 15, GENERATOWSIOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fidlyr and accurately described above by the propershlpping name, atm are classified, packaged, <br /> marked and labelediplacarded, and are in all respects in proper condition for transport according to applicable International and notional governmental regulations, if export shipment and l am the Primary <br /> Exponeq I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I codify that the waste minimization statement Notified in 40 CFR 262.27(a) (if l em a large quantity generator) or gal (it] am a small quantity tar) Is two, <br /> GeneratorslOtferors P 'nted erne _ Signature Month Day Year <br /> 16. Intensional Shipments '.. <br /> F ❑ Im rt to U.S. ❑ Export from U.S. Port of entry/exit <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. Tramponer-Acknowledgment of Receipt of Materials A <br /> a Transports 1 P 'nte Ry ed Name Sign is Month Day Year <br /> O /fid^ <br /> O <br /> Transporte -2 Printed ed Name Signaturf Month Day Year <br /> r _ <br /> 18. Discrepancy - <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> 3 . <br /> U <br /> LL Facility's Phone: <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day YearCD <br /> ',... <br /> Q <br /> CD <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes forhazardouswaste treatment, disposal;and recycling systems) <br /> 12 <br /> 20. Designated Facility Owner of Operator. Cedificalfon of receipt of hozrdous roadals covered by the manifest except as acted in Item 18a <br /> Pdntedlfyped Name, . Signature Month Day Year <br /> EPA Farm 8700-22 (Rev. 3-05) Prev us editions are o solate. DESIGNATED rAC9LaTSf TO DESTINATION STATE (I MQWRED) ', <br />