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Please print or type. Form Approved. OMB No, 2050.0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page i of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST CAL000407015 I ffi&7M7225 1 012283479- r C <br /> L E <br /> 5, Generators Name and Mailing Address Generator's Site Address (if different than mailing address) <br /> Niagara BMIing . <br /> StDC CA 952M <br /> Generators Phone: <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> .; cW Chamcal Tfranspcd I . / . AC- IRO <br /> 7. Transporter 2 Com,�a ny Name U.S. EPA ID Number <br /> f)r K System, i <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> 2730 E Yurna LUC <br /> 1 t AMOD05116924 <br /> ' a <br /> Facility's Phone: 344 <br /> ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers i1 . Total Q. Unit 13, Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity WLiV011 <br /> Ix 1 • : - RCR A Hazardous Waste, Salki , (Oily oftds) P 352 <br /> 0 <br /> IMM <br /> Z 2. <br /> LLJ <br /> 3. <br /> 4. <br /> 14, Special Handling Instructions and Additional Information Prejed <br /> } 175M DWMalt 0244421 <br /> 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, arca are classified, Packaged, <br /> marked and labelediplacarded, and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations. If export shipment and I am the Primary <br /> Exporter, i certify that the contents of this consgnment 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] am a small quantity generator) is bve. <br /> [77atoeslOfferoes PrintedlTyped Name Signature Month Day Year <br /> 16. International Shipments € po <br /> mi rt to U.S ❑ Export from U.S. Port of entrylexit: <br /> IN" <br /> ? Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. TransporterAcknow"menl of Receipt of Materials <br /> LU Tra porter 1 Printedf�yped lame „ Signature Month Day Year <br /> 0 /f r <br /> z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 9 <br /> h <br /> 18. Discrepancy <br /> 18a. Discrepancy indication Space ❑ Quantity ❑ Type, ❑ Residue 0 Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> F 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J_ <br /> V <br /> Facility's Phone: <br /> LU 18,;. Sgna'=ee of Alternate Facrity (c�r Generator) Month Day Year <br /> Q <br /> z <br /> 19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recycling systems) <br /> A 1. 2, 3. 4, <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> PrinledfTyped Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 12.17) Previous editions are obsolete. GENERATOR' S INITIAL COPY <br />