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Please�rint or type.(Form designed for use on elite(12-pitch) a�2137291-002 <br /> ( P' )typewriter.) SC 11Sd200$ <br /> UNIFORMNaZARpOUS 1 CeneratwlDNumber FormAooroved,grggnro ". <br /> °'^S'C�7r1N1rtST (; v� $ -•-a��r 11.0 ;nse rnone 4.Manifest Tracking Number <br /> 5.Generator's Name and Address (800)483-37ig 0 02200564 <br /> ?t <br /> r store T 1326 Generators Site Address(if different than mailing address) L1 ��� <br /> 280 Spm*ws Aw <br /> Mama",CA 95336 SAME <br /> Generators Phone: (209)82"982 <br /> 6.Transporter 1 ompeny ame <br /> CIM 118ftrs EwAronmmw SB*VIO a Ina U.S.EPA ID Number <br /> 7.Transporter 2 Company Name M A D U 3 9 3 2 2 2 S 0 <br /> U.S.EPA ID Number <br /> 8.Designated Facility Nacos and Site Address <br /> 10�Harbors Sart loss LLC <br /> U.S.EPA ID Number <br /> son l4ss, 951333 CA00594943iO <br /> FacilitysPhone: (408)441.0982 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class ID Number, <br /> HM and Packing Group(if any)) 10.Containers <br /> 1. 11.Total 92.Unit <br /> 3 3 :;i a j! No. Type Quantity Wt'-Ncl. 13.Waste Codes <br /> t- X DOT-Sp 31398 <br /> 001 Df 0005' P 331 D001 <br /> W 2' UM99E, <br /> c, X � 11AlMAKE LIQUIDS,LS, <br /> , °S LFUM DISIILLAT£S13,PG 11 001 DF 0002 R 331 W01 <br /> 3. UH"84,WAM HYDROGE14 P+En.yiDE,�UE'o <br /> 910 1 D P 0001 p 341 x'001 <br /> i <br /> a. 'UN2902 tPE11011DES,LI UID T4J)!(fIC,1d.9.$,, - <br /> 'A `r AA <br /> ��?2L 6.1,Ih'1a ori 0 0 0 2 P 232 331 <br /> 14.Special Handling I1 :1 :ens,J,!! itionat Irrbwma@cn <br /> 1.TARGET-LCrRQ �G'1325 <br /> 2.CH329965 1X30 �3.7r1�ar�8i FLEET*523; <br /> 3.E�G ERGl129 lX� <br /> 4.CH329972 F•RGf140 1X5 <br /> 15. GENERATOR' 1X5 <br /> S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above the Proper marked and labeled/placarded,and are in all respects in proper condition fw transport oxo <br /> Exporter,I g by p per shipping name,and are classified,packaged, <br /> certify that the contents of this consign c�rrform t°the terms of the attached EPAAcknowiedgmnte of Consent. <br /> Ming to knO cable International of tions and national governmental regulations.If export shipment and I am the primary <br /> I certify that the waste Minimization statement identified rn 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a I quantity g to is trtr®. <br /> Generator rots tin yped � <br /> Maine <br /> ay ear <br /> 16.International Shipments <br /> z ❑Importto U,S. ❑ 1121 +08 <br /> Trans rter si nature for exports onI . Export from U.S. Port of entry/exit: <br /> W 17.Transporter Acknowledgment of Receipt of Mater els Date leav n U.S.: <br /> OTransporter 1 Printed/Typed Name <br /> CL MARC SANTIAGO III Signature <br /> QM Tr aY Year <br /> Transporter Z Printed/Typed Name Li <br /> ignature 11 21 08 <br /> 18.Discrepancy _ -_ __ _ - _ _- - - - _ - Mon _ay ear_ <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity El Type <br /> ❑Residue 0-Partial Rejection <br /> ❑Full Rejection <br /> 18b..Alternate Facility(or Generator) Man fest Reference Number <br /> J <br /> EPA ID Number <br /> '. Facili 's Phone: <br /> y 18c.Signature of Alternate Facility(or Generator) <br /> cc <br /> a Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2• 3. <br /> 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 /> P' drrypedName re Month Day Year <br /> VPA Form 8700-22Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />