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Ptl riljtoilype. <br /> , Form Approved.OMB No:2050-0039 <br /> 1.Generato ID Number-11 51, 2 Page 1 of ,3.iEme �y Response Phone' 4.Manifest Tracking Numbet <br /> UNIFORM HAZARDOUS (,; ttr , <br /> �/ <br /> °Y15`TE MANIFEST CtOsD $^� I — a�t JJ K <br /> 5.Generator's Name and MailingAddress 5�,r i; R Generator;51 Address(if different than mailing atldress) t <br /> P GA CAS zr;DD, A BOL' EIN OSE <br /> f aw 1 STANFORD,91) <br /> Tiffs_C(� ;� <br /> Generators Phone:. <br /> 6.Transporter 1 Company Name': _ U.S.EPA ID Number <br /> P 13FIC R-E URGE• RECOVERY SERVICES <br /> 7 Transporter2 Company Name,: "r _ . U:S EPAID,NOmbeT <br /> 8.Designated facility Name and Site Address U.S.EPA ID.Number <br /> "Oki 0 C RESOURCE RECOVERY SERVICES GPt? kS2405 <br /> 3150 EAST P I CO BLVD. <br /> LOS ANGELES, CA qinn <br /> Facility's Phone: (800) 449-7145 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total . 12.Unit 13.jWaste Codes <br /> HM and Packing Group(If an r. No. Type Quantity Wt.Noi. <br /> :. 1!lolly WASTE <br /> P IT €(ELATD MATER I #L, , ''1301 <br /> D 1 Frtd� S <br /> 0 , <br /> PSI I'� I ,. (Doal <br /> LU j t <br /> t <br /> a.l�ICII�i. RCRA HAZARDOUS WASTE LIUliIL� 433 <br /> (WATERBORNE CLE6 KING' 'SOLUT1 t4 <br /> Dry . v <br /> 14.Special Handling Instruction's and Additional Information � - 33dT':Apt- -91Jp - g <br /> v� <br /> GLOVES �lL3��Ei & PROTECTIVE <br /> OTECTIVCeOHING 241AR EMERGENCY <br /> ggERGNgY CONTACT.-" L I RK. <br /> WA LRF .:; -.. .. <br /> - <br /> ERID i W' 9b4 P NONE, I 1 <br /> TR NSPORTER. 1 PHONE 14688-213-1346 ,I SII, MIN ,I 1 ll sly t11: ll . I I <br /> 15. GENERATOWSIOFFEROKS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described,boys by'the proper shipping narne,aid are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport.according to applicable international 'd natipnal bob mental regulations.Ifexport shipment and l am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAoknowiedgmentof Co t. <br /> I certify that the waste minimization statement identified in 40 CFR 262;27(a)(if Lama large quantity genera r)of(b am a small quan r)is true. <br /> G erators/ fferoes Prin d/ ' Month Day YeaC <br /> .1 Name <br /> 16.Int e ational Shipments <br /> 0 .;.. <br /> Import to U;S:.l' } ❑Ex ort fro $. Port of entrylexit: <br /> z Transporter signature(for exports only): Date leaving U.S:: <br /> tL• 17.Transport"k*fiowledgmant of Receipt of Materials <br /> rans(�gperkPt /Typed Na'" 1 3 gnature Month pay, ' Year <br /> intetl <br /> z Transporter2Printetl/TypedName r S re." Month Day, :Year <br /> Ir <br /> 18.Discrepancy <br /> 8a.Discre anc Indican <br /> Discrepancy on Space El Quantity ❑Type. <br /> 1 <br /> 1-1 Residue � El Partial Rejection. El FullRejection . <br /> Manifest Reference.Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Facility's Phone: , <br /> .. <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> t= <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal;and recycling systems) <br /> G 1, 2. 3. <br /> T- <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 /> Printedll A d Name Signatu Month Day Year.. <br /> c <br /> D <br /> EPA Form 8700-22(Rev.12-17) Previous editions areplosolete. F•. <br />