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Please rentor pe,(Formdesigned foruseonelle(i -pitch)typewriter.) <br /> UNIFORMHAZARDOUS I.GanotalorIDNumber Form Approved,OMB No.20�60_0039 <br /> J"i 01 f 3,Em9Tgenc;yRhspo OPhone 4.MaM108t Tracking Number <br /> WASTE-MANIFEST <br /> 5.Ganwalor's Name and Mailing 005824:2.2-A 0 SKS� <br /> Genoralor'sSilo Address(If dIfforent than mailing A00fass) <br /> ]Ito <br /> 1,'4 <br /> vl <br /> 71 <br /> Genstalor's Phone; <br /> 6.Transporter 1 Company Name <br /> US,EPNDNumber <br /> C3 V IS f".In i <br /> 3, <br /> 7.Tlareporter 2 Company <br /> UA WNW Number <br /> GLEAN Hf-�RKJM6 <br /> 8.Designated Facility Name and Site Address IN AD P.31) <br /> t"I""m ':}mm jQ,,)E' U,S.EPA ID umber <br /> I — <br /> jf�?' 'I <br /> I JOSE, '113 <br /> Facility's Phone: <br /> 9a, 9U,U.S,DOT Description(including Proper ShIppi 9 Name;Hazard Class,ID Number, 4.)43A <br /> HM and Packing Group(if any)) I Containers <br /> 11,Total12,Unit I i <br /> Quantity <br /> Wt./Vol. 13,Waste Codes <br /> Type <br /> 1.U-1 <br /> Uj <br /> 2. <br /> 4, <br /> 14.Special Handling Instructions and Additional ITtiZ <br /> TFI) <br /> y d6c re, 6�6*4 MO,aril are classified,packaged! <br /> marked and laboleditplacarded,and are In 911 respects n r at <br /> E 0 'S ott IS dt � ff 1'1't�Fiffi nt <br /> p conditionfidrtransport accordIng to applicable International and national governmental regulations,It export shipment and I am the Primary I <br /> Exporter,I certify that the contents of this consignment conto the forms of the attached EPAAcknowledgment of Consent. <br /> I certify[hat the Waste minimization attalcmant Ids tin <br /> .In 40 CPR 262,27(a)(IN am a large quantity generator)or M(fit am a small quantity generator)Is true, <br /> Gbndr9;(_qe;tff;ro?`$Pilrilodfryped Name i Signa-- ture 7_ <br /> Month Day Year <br /> 16,Inter allonals loman't's <br /> Import El rxp,,d from U.S, Port orerllrylaxil: <br /> Z Transporter signature(for Amnrig nnivil, j Date leaving U.S,: <br /> 17,TransporterAcknowledgment of Receipt of Matodalsj <br /> Transpodeg Printed/Typed Name <br /> Month Year <br /> .7 <br /> h1651h D(y Year <br /> 10.Discrepancy <br /> 188.Discrepancy Indication Space <br /> El Quantity' ElTyp, ❑Residue ❑Partial Rejection <br /> Full Rejectionl <br /> 18b.Alternate Faciii. (or Generator) Mantlest Reference Number: <br /> U.8.EPA ID Number <br /> cs <br /> I-L Facilitys Phone: <br /> 18c,SignatureofAltermate Facili flor_Generafor) <br /> =tAo=nthDayjyyear <br /> &5 19.Hazardous Waste Report Management Mel <br /> UJ 1, hod Codk(l;i codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. <br /> 4. <br /> I d <br /> ;Facility Owner or OPOQ'Icl`�'C00.110n Ited <br /> 20.Designated Facility Owner or Operator:COVIlliCallOn fte sift of hazardous:maledals covered by IM nifest except as noted In Item 18a <br /> Na <br /> 0 <br /> P?intedfTypad Name <br /> Signatureii Month bay Y ear <br /> I <br /> EPA Form 8700-22(Rev,3.05) Previous editions are bed ote. I I I <br /> :1"R! <br /> 1 , 11'7 ii GENERATOR'S INITIAL COPY <br />