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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.MUf t Trrac705941 g Number WASTE MANIFEST CAR 1� i a3®„7�r7225 V. "F F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Min Ekictronics ho 199 Frank Wiest Stocidon, CA 952M Generator's Phone: 7 6.Transporter 1 Company Name U.S.EPA ID Number Adman ad 01eMi0W 7ianspad b1c.013A ACTeVT4ro OAROtxk)70540 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number WoW 09 R� CATWW13M 2=N Alsrr ods S Compton, CA OOM Facility's Phone: (31{1)537-7100 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./Vol.. 1 NoWRCRA Haaardrws Wastes tjgWd(04 ,+ P 221 O �"x Z 2. L 0 3. f I 4. 14.Special Handling Instructions and Additional Information 2481M owuftwt L:- 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 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 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)(if l am a small quenGty genqutor)is true. G@gerator'sl0fferor'si+ltedlType Name / ! 4% SXture � �` � Mgpth Day Year. J 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporterr,cknowledgment of Receipt of Materials � Transporter 1 Printed/Typed Name � Signature th Day O W «i A � J a QTransporter 2 Printed/Typed Name Signature ' Month Day Year cY � 18.Discrepancy 18a.Discrepancy Indication Space Quantity Type El Residue Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z Fn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. T 4. 1 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