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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 .//G++enn�or�m� or ID Number 2. Pagge 1 of �3,,EErmlerggetncy Response Phone c/ 4. Manifest Tracking Number WASTE MANIFEST `t7�.Oet? l}G �j �J' h ry b '? Tj "LL} Gp 015879196 JJ 5�-G e�alor a AMavlli Item;� �0 CAl ?g ER t;9P ( fftREL Generators SlteAddress (if differentthan mailing address) 76 .79 Loll c5T S,TcCf4Togr CA g5 *Lc) G Generators Phone: Ct 23 4 ' C3 0 6. Transporter 1 Company Name U.S. EPA ID Number 7. Transporter 2 Company Name U.S, EPA ID Number B. Designated Facility Name and Site Address US. EPA ID Number efli luiL w&5tE 1v►ANAGEMp-Nr ! NG .352.5 [ 0Ll j CEA )aLi ye ft J<-p,rry *p/AAA/ CI, y, CA 93L3`i 50 3X'� 9W1 Facility's Phone: - go, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total V. Unit 13, Waste Codes HM and Packing Group (if any)) No. Type Quantity WtNol. o �lGN i2LRR .} zapbojm' s l,Vftr6, SOLID 01 Cin y rz 2. I I j 3. 4. 14. Special Handling instructions and Additional Information , 7 ?CHJ75i •SLR' '7Nsgis3cl lPIWF°IL L } CA P0099'59L 1 1 l G'N W " 122- 151 cbb SDLVrC 15. GENERATOR'SIOFFEROR'S 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, marked and labelediplacarded, and are In all mspects 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 cedlfy that the waste minimization statement ldenifle In 40 CFR 26227(a) (if i am a large quantity generator) or (b) (if I am a small quantity g elfifor) Is true. GeneratorsiOffamrs Priplad/T d Name Signature / _ Month Day Year J 16, International Shipments - h ❑ Import to U.S. ❑ Expartfrom U.S. . Pod of entry/exit z Transporter signature (for exports only): Date leaving.U.S.: 17. Transpo ierAcknowledgment of Receipt of Materials Transporter I Prinleciffyped Name Sigriatur C Month Oay Year CL 4 v QTransporter 2 PrinledlTyped Name . Sigd2m Month Day Year U1. Discrepancy 18a. Discrepancy Indication Space ❑ quantity - ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: Tim. Alternate Facility (or Generator) U.S. EPA ID Number V <a Faciltlys Phone: - w 18c. Signature of Alternate Facility (or Generator) Month Day Year CDQ z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 0 1. ? 2. 3. 4. J 20. Designated Facility Owner or Operator: Codification of receipt or hazardous materials covered by the manifest except as noted in Item 18a Pit ntedffyed Name Signature . Month Day Year se % g I to l e EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IH REQUIRED)