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°lease proal art .(Form desi0ned for use on elite(12-pitch)typ yriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS__ 1.Ganarator 0 Numbr r.Png 1 of 3.Emergency Response Pi4.Manifest Tracking Number <br /> WASTE MANIFEST , FLE <br /> 5,Ceaerattoft Name find Mailing Add°�a i�ffmrd tt esR(t rent than matting lttiess7 <br /> 3725 N Tracy Blvd <br /> ] rdcy_CA 95 104 <br /> -sner�cr`Phone <br /> r rarest orter ' rr rly _ iti U,&EPA ID Nwnbet <br /> 7gA,,;ter ComharTy Nmne U.S. A uml?d�r <br /> T z N2. <br /> 8.fr'o,�,iq+wated Facility Na:fie and Sile Pd. ass U,S EPA ID Nrurber <br /> ��;;1i�''a.t: i. < I� tit•rl,. <br /> Faaht's Plwartea <br /> ge 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Pacidng Group(if any)) No, Typa Quantity Wt.Nol. <br /> 1. <br /> o Ljbl 1003,V';ta,te Flammable Liquid,WO.S- . NG IIf i( as a <br /> � i��later) x <br /> w I <br /> Z 2. <br /> w <br /> fl A <br /> Non RGT,A Hazardous Vjaste Solid <br /> ....__.__.. <br /> 1 l <br /> 1.1..Sp ai.A Handling hrstrudons and.Addilnnal Infomtation <br /> V-i't AR— PPi; Profile %j <br /> EMERGENCY Ct�td Z w(--,Ff E HOOFS ' <br /> ? GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping nerna,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,Itexport shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(if I am a small quantity generator)Is We. <br /> G+rnc�€ata> as sn amnisignat MOIRAYear <br /> r)dAaLL6-'- 1',w 6> , ,, a ? <br /> -+ i6.tr tematltl Ipmerris —_ <br /> Importto U.S, F-1 Export from U.S. Port of entry/exit: <br /> Tran signatin Tor exports only): Date feavq U <br /> 17.TrarsporterAcknowAd <br /> egrnent of Receipt of Materials �`f <br /> Flo taari <br /> TranaperWr 1 Prm yped Name �,.....�.�. . mss- gnature 4 <br /> 0 <br /> n. <br /> TrAiss�r�rtar2-PrkNeradNarr � .:, store ontn oar <br /> 18.Discrepancy nn <br /> 10x,f?icr„ y Indication Space ty Type •• <br /> Partial Rejection L J Pull Rejection <br /> Quanti LJ osidui: <br /> Manif-,stReiemrxe Number: <br /> Sia etema;Fadllty(cMeneralcr) U.S.EPA ID%mbor <br /> Zi <br /> c) <br /> d <br /> FaciiN,$ <br /> w 77,Sjgneture Agttmate F y(or QAt-favil A4ontil Day Volar <br /> Q <br /> z <br /> 19.Hazardous Waste Report Managemer:.'Method Codes(iia.,codes for hazardous waste treatment,disposal,and recyctirtg systems) <br /> o i 2. 3. 4. <br /> 20.Designated Facility Owrer o-Oprr31w;Certification of receipt of h t materials covered by the manifest except as noted in Item 18a <br /> Txrtinl / Month y Year <br /> Signature <br /> 4- <br /> PAFonm 8700-22(Rev. 4) PMvious editions are oomew, DESIGNATED FACILITY T(7 DESTINATION STATE(IF REQt11R 1 <br />