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,.14i:f P;#' 026814,196 ;
<br /> Pluse print or type,
<br /> 70ano
<br /> ,Generator) Nu per Form Approved,.OMB No,2050.0039
<br /> RM HAZARDOUS 2,Page 1 of 3.Emer�eneyRes onse—Phone 4.M��anyylfestTraoking Numberp
<br /> STE MANIFEST ;;, !"f ! 6;ii!114,r3 11 F ! 3 r7 r413 w� U d0»
<br /> �.
<br /> rators Name and Mailing Ad µ o Generators SIteAddress(ii difremnt'than maling.address)
<br /> Cl ac'o Ail- �jr i1t+Y,y :ft /.?th 5(fs)ti"r r6')i�f FIN)0 A ' t.. +,t.�i or's Phone. >� w!4 ty•^ ?pporter)Com an Name}.LTY"'I�LEF,f) -Ya rZeN tN' U,5•fPAiD Number
<br /> orter 2 Company Name AN HP,. BC,, C), EN'�II•,R MUYI;'NTAIL, SVC: INC, VS.EPAIDNumber
<br /> ated Facility Name and Sita Address KVIN HAMORS Mari x,088 7 U.S,EPA ID Number
<br /> 1.081 BERRY SA ROAD
<br /> SAN
<br /> "M-111141-00:1116r,
<br /> Facility's Phono: CA 91 33 C:A,Ly�15�`1F'�4�?1 Ci
<br /> ga, 9b.U:S.DOT Descdptlon(including Prop r Shipping Name,Hazard Class,10 Number, 1p,Cdntalners
<br /> HM and Packing Group(if any)) i1,Total 12,Unit 13.Waste Codas
<br /> No, Type Quantity WL/Voll
<br /> a ' *-Ii�� hdUN RCCA I� :
<br /> l��)�r��11W � DPI P 2;�.:
<br /> ( E ?.Ia".r nTttl3t.1•l1 . HYD`�tE.11'�t•)E�r.lf,41'), hb/A
<br /> 3•
<br /> 4,
<br /> 14.Special Handling inslnrctions andAddilionallnfeMallon
<br /> � S1s 7t1,„rltrGl' # + 37433 C s
<br /> 244 Ei�llw;�l 3;�rC; �1 ,�',�10_k r 1'7E0-CH/EX/'TFI-'Calit r,a;ct r,etalinmd a Q7 �r��'arw
<br /> xielo{ n , r , r Fra a,1r :L! tail Nr r.r�9r r-ta M 1.
<br /> I 5• GENERATDR'SIOFFEROR'S CERTIFICATIO ;I h,rebydeclare that the contenlsotINS consignment are Ml a dTaccurate des iibed'abova b iha ro a shi n n aassified acka etl
<br /> marked and labeled/placarded,and are in all re peas in proper condition for transport according to appiicabie9ntemationaland natonal ovemmeniai P P. PP g P g
<br /> Exporter,I certify that the contents of this const melt conform to the terms of'Ihe attached EPAAcknowletlgmentofConsant,
<br /> g regulations.if export shipmenfan{i i ant the Primary
<br /> ttify that the waste minimization statements.entified In 40 CFR 262.27(x)(it t am a large quantity generator)or(b)(iff'm a small quantity.generator)is true,
<br /> enerptd?`E oror's Printedtfyped Na Signature 5'
<br /> , ,S•,.. Montt Day f Year
<br /> ,.,.r 16.Intematonal Shipments f—� —' -- 'r I r D 1 1
<br /> F- ❑import I, S. ❑Export f,,,,,U.S. ort f enbylexitr'
<br /> ? Transporter signature(for export,:only): 'N g US.: j
<br /> W 17,Transp a Acknowledgment of Receipt of Material rUj
<br /> . ----=--
<br /> Trans r t Pd ed/fyped Nama.� rC / �'it`' .` ,. � '4.1__ G' ✓ �'� ', apr
<br /> _ Month Day
<br /> Y
<br /> Trans porier 2 Pdnfedliyped Name �
<br /> r r
<br /> Signature Munih' Day '';Yda'r"
<br /> 16.Discrepancy
<br /> 18a.Discrepancy Indication Space
<br /> ua
<br /> ❑ Q nlity ❑
<br /> Type YP ❑Residue p
<br /> ❑ arVai Ra ecUon.
<br /> ❑Full Rejection
<br /> 16b,Alternate Facility(or Generator) Manifest Reference Number.
<br /> U.S.EPA ID Number
<br /> Facility's Phone:
<br /> Signature ofAitemale Facility(or Generato()
<br /> Month Day Year
<br /> z
<br /> w19,Hazardous Waste Report Management Method Cod s{i,e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> 1• 2. 3. 4
<br /> t
<br /> 26.Designated Facility Owner or.Operator:Certification i If'receipt of hazardous materials covered by the franifest except as noted In item 18a
<br /> Ll PrintedFfyped Name Signature Month Day Year
<br /> i
<br /> EPA Form 8r700 22(Rev 12-17) Previous edfiions are obs lete. G NERA7I -INITIAL COPY
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