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Form Please�irint$or q(pe; Approved.OMB No.2050-OU39 1.Generator ID Number 2.Page 1 of 3.Em Response Phone 4.Manifest Tracking Ngmber UNIFORM WAZARDOUS -02-2259150 ��K WSTIIANIFEST ff�l.>� �3 �f �£7�3 i 9°' 0w.. °ra ?ia s ` 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) 18501 STANrook, RO Generator's Phone: # " ` 4-1,4,94 6.Transporter 1 Company name. U.S.EPA ID Number - I AC1r IIN RI~'-;O€3RCE RECOVE RY QERV' F�a f;@��$t�l 1ac��t��3 A 7.Transporter 2 Company Name U.S.EPA ID Number, 8.Designated Facility Name and Site Address U.S.EPA ID Number r1TWITFU. RESOURCE RECOVERY gERVTCES3150 EAST PICO OLVD. Facilitys Phone: X00� 4 9.9 f",j5? ga 9b:U.S.DOT Description(including Proper Stripping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.haste Codes HM 'a�dPacking Group(if any)) No. Type Quantity Wt.Nol. ''1 :Obs ul t14.O. :s 4rP6, 4141 ,;( Rf:,R,:' HAI. POIK3, WASTE- 1,100ID 14.Special Handling Instructions and Additional Information V40 ; 'Or" :1ksA) t) r � R u3l— E'51 a t CXW-*LES PROTECTIVC M 0 �~% «414R (f 9 #aLt (''A CONTACT;� $':F.R W111-133OPF {� R x' #s 40s V1 ,NO �111111 1 11111111111111111111111111111 11 A N iE 1 1 11tf 1 1 1 ig111p fillq 01 15. GENERATOR'S/OFFEROR'S CERTIFICAT19N:,I hereby 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/pia6arded,and are in,all tespects in proper condition for transport according to applicable intemationaland 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 EPA Acknowledgment of Consent: I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(III am a small quantity generator)is true. Oe0erator s/0fferor s Printed/Typed Na Sisipature `'" `^ Month Day Year 16.International Shipments ❑Import to U.S. QExport from U.S. Fort of entry/exit: r Z Transporter signature(for,exports only): Date leaving U.S.: - 17.Transporter Acknowledgment of Receipt of MaterialsUj - r Transporter 1 Printed/Typed Name'' t Signature �) Month. Day Year OCL :r y€ Transporter 2 Printed/Typed Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space 1:1 Quantity ❑ Residue pe T y 1 Type ❑ ❑Partial Rejection El Re ection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i:e.,codes for hazardous waste treatment,disposal,and recycling systems) Uj 1, 2: 3. 4. Y 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY