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L Veltfti8i Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Farm Approved, OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Pagel of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST i- A L f 0 Pt sot U 7 s 9 5 'f ( BL3) c12/u-- 9200 011178630 JJ KIIIIIIIIIId 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) ARAMAaPPi 76179 S, LONGE 5T. Generator's Phone: B. Trans o or Company Name „ pT U,S�EPA ID Num or �1 7, Transporter Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S, EPA ID Number CHElAIC2Ai Vi/A13d E MANIIAGEMENT, INC. 3526+1 _ILC? SKYLINE ROAD C A T 0 0 r 6 4 €7 1 4 1 KF-8"ILEPt§ANCITY CA93238 Facilil Is Phone: no, 91b. U.S. DOT Desorption (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group IS any)) No. Type Quantity Wt.Nol. i Or 1. NON RCRA HA-7JT%RI OUS '4VK-BTE SOLICr ey 110111-852 I 4. 3. I 14. Special Handlin Instructions andAddifional Information C IBATREC FC:ONTRA i #!_:CN24117 15. GENERATOR'SIOFFEROWS CERTIFICATION; l hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are In all respects In proper condition for transport 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 cerfify 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 mum GenomtofsfOg rioted d area t e Signature A Month Day Year ® r v are I J 16. International Shipments ❑ i— portImla U.S, Export from U.S. Port ofenlry/exit. Transporter signature (for exports only): Dale leaving U.S.: W 17. TransporterAcknowledgment of Receipt or Materials _ j2 Tran P ' tedityped Name Signatupae, IMonth Day Ye Nl Trans r rg Printedlfy ed Name Signature Month Day Year h 18, Discrepancy 18a. Discrepancy Indication Space ❑ Casualty ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection . Manifest Reference Number: 18b, Alternate Facility (or Generator) - U.S. EPA ID Number J U oFacilitys Phone: Month Day Year w 16o. Signature ofAlternate Facility (or Generator) Q 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a ' Prin edf ,, d Name Signature Month Day Year s EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete. DESIGNATED FACILITY Tb DESTINATION STATE (IE REQUIRED)