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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 3. Emergency Response Phone 4. Manifest Numher <br /> WASTE MANIFEST . ;: L t0 0 0 4 0 u 1 ( 200) 424- 9900 �� <br /> 6. Generators Name and Mailing Address Generator's Site Address (it mitmenithan malting address) <br /> AtIRAIt7fARK <br /> 7679 S. Lt7W E ST. <br /> STf tCt°>-1 ON CA 95206 <br /> Generators Phone: 209 234 ' 01 015 <br /> 6. Transporter 1 Company Name 1 U.S. EPA IO Number <br /> 7. Transporter 2 Company Name U.S, EPAID Number <br /> 8. Designated Faclltty Name and SiteAddress U.S. EPA ID Number <br /> CCE IICALWA 3TE MANAGEMENT,, INC, <br /> 35251 OLD SAYLINE ROAD C A T 0 L 0 0 4 0 1 1 7 <br /> KETTLEA7IAN CITY CA93239 <br /> Faculty's Phone: I <br /> go. 96. 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 (Vany)) No. Typo Quantity Wt val. <br /> i' <br /> NON RC."R ;? He¢=.=f+;R'DC7€J E its,3 TE SOLID 49 f _ <br /> Y Bp <br /> "jPIPrP�cJs� � �{p y$tl <br /> 3. <br /> C9 YE� <br /> 4. pC pd <br /> 14. Special Handling Instructions and Additional Information �/f167 levAV � �� <br /> 1 . C;$f�I1Ff9�i V f <br /> 15. GENERATORWOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable international and national governmental regulators. 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 EPAAcknovdedgment of Consent. <br /> I artily that the waste minimizatlen statement Identified in 40 CFR 26227(a) (if I am a large quantity generator) or (b) (If I am a small quantlygene)ator) Is two. <br /> Genemtors/Offe ots ,P�/�tedlType atgp Signature/ Month Day Year <br /> 16. international Shipments ❑ '.. <br /> r � Impodto U. . Export tram U.S. Portofeniry/exiC <br /> z Transporter signature (for exports only): Date leaving U.S.; <br /> w 17. TmnspoderAcknowledgmentof Reaiptof Materials <br /> a Tm1 P 'n ociffyped Name Sign Month Day Year <br /> 6 <br /> Tran der 2 Printed/f ped Name - Signaw Month Day Year <br /> h <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 /> J <br /> U <br /> rel Facility's Phone; <br /> w 18c. SignalureofAltemate Facility (or Generator) - Month Day Year <br /> a <br /> N19. Hazardous Waste Report Management Method Codes (i.e., atlas for hazardous waste treatment, disposal, and recycling systems) '.. <br /> us 1 2. 3. 4. <br /> ® �V�� <br /> 20. Designated Facility Owneror Operator: Cedtfiation of recetptof ha rardous materials covered by the manifest except as noted in item Ise <br /> Printedffyped Name Signature Month Day Ye r <br /> A L "' I P `- C* 10111 <br /> EPA Form 8700-22 (Rev. 3.05) Previous editions are obsolete. DESEQNATED FACILITY TO QESTINATOON STATE (IF REQUIRED) <br />