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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) e 3 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of T3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST DHILO"'"1107 004907994 J J K 5.Gvsrtrtdan�P��Vitlg Address Generator s Site Address(if different than mailing address) 10998 S. K4,FL.A.N Rv. FFENCH CAMP,CA 9'23-1 Generators Phone: 2^9 rte„0970 S.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number pIJIUP W=—ST INO G 1RAL 7ER%ACES !PJC. C;AFL-.d317'S27 8.Desi ;iG'ty Name and Site Address U.S.EPA ID Number 215TC=" ?`(,.�4r4!'f3�. �V1V1r�v.w.e»�c, rc.f�pcJlw.tr.; OF tAevaL., L.LL 2095 ?�fL�51?355:.ie NEtbLANDS OFIRvE Er,,ST NV 8--n4D8 Facility s Phone: 75" �27aJ 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. lael We a 0.o.s: W "7b �� I z 2. W 3. s I 4. 14.Special Handling Ins(t, ctions,and ,Additional Information Difllls/2,0 erg 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propel 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 I am a small quantity generator)is true. Generators/Offeror's Pdntedrryped Nam Sign re—�, f Month Day Year J 16.International Shipments F ❑Import to U.S. ❑Export from U.S. ort of entry/exit: Transporter signature(for exports only): Date leaving U.S.: Lu 17.Transporter Acknowledgment of Receipt of Materials OTransporter 1 Pdntedrryped Signature Month Day Year IL ?--1 // /0 Q Transporter 2 Prin yped Name Sign re Month Day Year I to 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: tu 18c.Signature of Alternate Facility(or Generator) Month Day Year a z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,and recyclirg systems) W 0 1 ' 1 2. 3. 4. �`� 20 Designated Facility Owner or Operator:certification of receipt of hazardous materials covered by the manifest except apqated in Item 18a Printed I YPed Name Signature Month Day Year )I EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. n,—1 0—1 tl 12 : 41 [PtMGNATED F C LITY TO DESTINATION STATE(IF REQUIRED)