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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4. if t c' u e WASTE MANIFEST C, r t � g 33 FL E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Alain Electrarics lyra 199 Prtc 1lYsst a CA 95MGelnerator's P orle: 6.Transporter 1 Company Name =W U.S.EPA ID Number AdWMAdQ1a1'nlod TMrsport kw./DBA ACT+Ienuro CA 7©rAID 7.Transporter 2 Company Name U.S.EPA ID Number VVarkM*6 Reco y System, Fic CAROW1754M 8.Designated Facility Name and Site Address U.S.EPA ID Number 7730E 151h& ANSI SM Facility's Phone: 926444.OM ga• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 0 I Non-RCRA HwArc om Waste l,>"d,(Codw*err) P 1 9 W l#2.NOR-RCRA oate Wafts Seat(C3D3r Sobs) c� 3. 4. 14.Special Handling Instructions and Additional Information PM10d NI Mrib er QDC!lY1"I. til 2) 1914W AIY:-- `- • -` ` f 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 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 labelediplacarded,and are in all respects 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 EPAAcknowledgment of Consent. certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature 4 Month Day Year 16.International Shipments`11 444, ►r �'4 j.._ ❑Import to U.S. ❑Export from U.S. Portof entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials 1 Transporter 1 Prnted/Typed Name Signature Month Day Year a �a U) Transporter 2 Printedrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: LOU 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) p 1• 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY