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Z, Pia a print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number UNIFORM HAZARDOUS � f1� �, yt j, (- •WASTE MANIFEST S K r 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing a dress) ADIPSAA 6 F i; Oate Oatt"f"s.i t-,,. ,. o'('.r= i x!301 € " i'f' t to l i ft't r.r t•{., i t t f Generator's Phone: -• • `"- '? 6,Transporter 1 Com an Name U.S.EPA ID Number I, F,4 E TFH IF-F�.� I XF'a"tt=a, t. 7.Transporter 2 Company Name U.S.EPA ID Number i71 1• , 8.Designated Facility Name and Site Address S ,t=•If t•f, t kF" Ne` TFs# ;; t;t,fw U.S.EPA ID Number 6000 DEPTH' S'TRECT SACRAMENTO CA Facility's Phone: ga• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit a HM and Packing,Group(if any)) No. Type Quantity Wt•Nol. 13.Waste Codes 1-WON—RCRA HAZARDOUS UASTE, LIQUID o tAQUEOUS PARTS WASHERSt:fl UTTO €) z z: w • 3 4. _ 14.Special Handling Instructions and Additional Information )e==); rift,, elf =4 i 6r A -°F;1.firr i"h';1r,fj ( t" ,,.'.1 r.0C ;{ =r" Ft,t tl Ys r f ' . 11� { . � €,�.: "7��# � .a � ra•� ��. # �,'a}} a f r3 4 ` ESS'. �S �- r$ �r 3;.,.?t•:L-,� ,.� �..'-:; - 1,I. 15. GENERATOR'S/OFFEROR'S CERTIFICATION:Thereby declare that the.contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Con e > I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity 'frf generator)or(b) as small quantity generator)is true. Generator's/Offeror's Printedfiyped Name Suture E Month Day Year J 16.International Ship ents 5 F ❑Import to U.S. ❑Exportfrom U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: r 1w , 17;Transporter Acknowledgment of Receipt of Materials Ujd Transporter 1 Pririted/Typed'Name Signature Month Day Year aVie P U) Q Tra7 Printed/Typed Name Signature_ Month Day Year: 18.Discrepancy 18a.Discrepancy Indication Space El Quantity 1:1 Type F-1 Residue ❑Partial Rejection 1:1 Full Rejection" Manifest Reference Number: 18b.Alternate,Facility(or Generator) �r U:S.EPAID Number. t _ - V W Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) w1• 2. 3•' 4• 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the•mamfest except as noted In Item 18a Printed/TypedName!• j "': Signature �f Month` Day Year /17 EPA Form 8700 22 Re 9-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR