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Please print or tvn9.• <br />Form Approved. OMB No. 2.050-0039 <br />EPA Form'8700-22 (Rev. 12-17) Previous editions are obsolete. 3 71 1'.; ,, -j ;r i! .lc, roe -i <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone4. <br />Manifest Tracking Number <br />WhgfEMANIFtST <br />64(.G�j, .fj;as s., <br />1 <br />' JJ <br />5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />F ice. S1'.t T f'. 1['CK LE;. NIT 0 B A 'D ...1 R <br />4�i'•i'' �. !•i+;tr^,`,,!`ti:;ti�si,)iY-(V� i „;I'3i`•4 <br />Generator's Phone: <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />4)'i3O,. �'i7 "i_I<�, !,�'I'. ;J <br />I..('6 ANGELES, . (.A 9AJs:1--1 <br />Facility's Phone: (800,? -rj 99 -) 1.4 b <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />� <br />., <br />I. ,; 7 r. y t y A 1 F A. <br />L s 6 Wf' �' E A t ..v L <br />O <br />W <br />LU <br />3 �.!¢•t.� ! 4 I r3MH1,0i: L.(� ;�C .1.t)'tC <br />€.O:? v t ORGAN 1. l�; <br />! <br />IN <br />fCi <br />t'�'�y� V Wit, L`-tytj ..,,.�ISLiJr.. <br />` <br />:eranwvseu: <br />. <br />14. Special Handling Instructions and Additional Information <br />i r'W14 ,--28 9b2) t'P# 6/110 11, 9t-,3 ) AP# 6434a. <br />..hN ?4ts! li . iCYl`P?�'"4C1[11 1 R c•.Mr,R,7; N " t, <br />0 : 9 b I ) 3.28 9)x,2 ) 1, 26 9b1 3) 1 3S�„ <br />9�tkf744t1��)�7�i19$i�r�Vl�i.re �r' <br />PkONE 3-31348 <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Grator's//Offeror's Printedf ed NaW Signature Month Day Year <br />'16. International Shipments <br />❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: <br />? <br />Transporter signature (for exports only): Date leaving U.S.: <br />W <br />LLJ <br />17. TransporterAcknowledgment of Receipt of Materials <br />t2 <br />o <br />Trans o et�.RrRr� d/T ed Name � R. � .-. t Sig <br />p >$ rae ure Month Day Year <br />Transporter 2 Printed/Typed Name SO, tune Month Day Year <br />H <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type V ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />F <br />_ <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />U <br />' <br />Facility's Phone: <br />w <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />a <br />Z <br />N19, <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />4 <br />1. , <br />.. 1 <br />2. �,. <br />3. <br />4. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ncted-in Item 1 Be <br />Prin yped Narle Signature f Month Day Year <br />EPA Form'8700-22 (Rev. 12-17) Previous editions are obsolete. 3 71 1'.; ,, -j ;r i! .lc, roe -i <br />