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Please print or type.(Form designed for use on elite12- itch t I�Iill,11111111INI I ( P )typewriter.)1 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 9.Generator ID Number 2.Page 1 of 3,Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST r.gi 1 ^� 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) jl0}.sa.; �eriGr i i �`� 1� Alar 3eneT''.al i3'�++'?:'. Generator's Phone. qTn r Ttnm- -'u >�r'" -F.7�F? 6.Transporter i Company Name U.S. PAID Number q' -rir y r-^1a Rnar i ga - i:ac�Ea qn%r. s_nnc DZLCJUjA 11 1q�fa 7.Transporter 2 Company Name' - U.S.EPA ID Number 8.Designated Facility Name and Site Address General environmental Mgt, LLC U.S_EPA IDNumber 11655 'White Rock Road Ran--he Cerdava, CA 95742 Facili i s Phone: -1 _�51LA980I A - 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10 Containers 11.Total 12,Unit HM and Packing Group(if any)) 13.Waste Codes No Type Quantity Wt.Nol. X 1Non RCRA hazardous waste, liquid (Consumer 1 BF 00055 P 331 Products), z 2. LU 3. 4. E 14.Special Handling Instructions and Additional Information 1. 110524(Non-RCRA Liquid Waste (CA Only) - Loosepack) 15. [GENERATOR BPOFiFOMS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper ahippktgm mm.,Z am dassilEed,packaged,. marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.Ifexport 8 0rieilt and If am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity grn,ratdr)is true. C—Alwavor's Rory-pm mel /�{ nature Month ay ear -1 16.Intern-alla Shipments Elrr��--��Import to U.S. LJ Export from U.S. Port of entry/exit Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrinteclfTyped Namegnature onth a Year c' Y CL :..i Z Tana r 2 PrinT'" ype-it a signature Mom y- 18 Discrepancy 18a,Discrepancy Indication Space Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V Q ti Facility's Phone: w 18C.Signature of Alternate Facifity(or Generator) Month Day Year Q 1 Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) o " H ILI f 2. 3, 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed �fName t / Signature Month Day ear It QY4`iRe I is 2 , f IN 102117 EPA Form 8700-2/(P// 3-05) Previous editions are obsolete• 61 / DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)