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Please print or lype. © 15 V Form Approyecl.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3,Emergency Response Phone 4.Mabe Tr Id r4 21 <br /> WASTE MANIFEST CAD91919701125 8•4-S76-13 1 U 1 4 F L E <br /> 5.Ganerrrinr's Nama ar rl Ma+ling Address Ganerator's Silo Address I.if diHere nl than malling address) <br /> Cir of LWI gectric Utility CHr of I"8oct k UdIlty <br /> 1331 &Horn Lane 1391 S.Mom Lam <br /> Lodi CA 95242 LodL CA 45242 <br /> Ganeralor's Piwne 209-333.6800 Xt 2745 209-353-00 A 2745 <br /> 6.Transporter 1 Company Name U.S EPA ID Number <br /> EnwildTruwomwrInc IFLR000168203 <br /> �ranspo ter 2 Crrmpnny Name U S.EPA ID Numbor <br /> 8,Designated Facility Name and Site Address U.S.EPA ID Number <br /> Clean Hmrtaors,(DBA Emerald Transformer Las Angeles LLC) <br /> S7S6 Alba Str"t <br /> Los Angeles,CA 90058 <br /> Facility's Phone: 323-277-2500 ICAD050806850 <br /> 9a 9b U S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No Quantity WI.Nol. <br /> Doug AAMLIQUI rM 39irM <br /> o stn <br /> WA <br /> 0 ?(T'rarWorrrler wfoll<2ppirrn PCBs UQLIID 221 <br /> 5 C ,, <br /> 3UNZ31 S Pol oil In BI pp srUQU I_d,9,PG II 731 <br /> (Tlrans owner-Oil Filled>SOOpprn Yas) M �) _ <br /> C <br /> r <br /> on- Wileui SM <br /> iM — rM <br /> 14.5pegal hlandlinq Inslruclions anclAddilional Inlormalrun <br /> LOD401 Bo $s A CM <br /> 3 L OO.004 CH17xFi)[FAG 177 ?-A c M <br /> M ft&venq Resiixam Contact:Emerald Transforms. <br /> 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, <br /> 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 <br /> Exporter,I certify that the ccnlenls of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if]am a small quantity generator)is true. <br /> Cienoralors!011ere7s Pri d!T Iin[l Name I ll Signature Month Day Year <br /> Yl 6L ll' eC r°CU�P�P Y �(ttl �Z p <br /> 16.International Shipments <br /> ❑Import to U S. ❑Export from U.S. Port of enlrylexil: _ <br /> ? Transporter s gnalure(for exports only): Dale leaving U.S. <br /> W 17.TransporlerAcknowledgment of Receipt of Materials <br /> LLI <br /> Transporter}arintedfTyped Name Srgnatwe f,4onth Day Year <br /> OLe <br /> z Transporter 2 PrintedlTyped Name Signature Month Day Year <br /> 18 Discrepancy t, <br /> 1Ia.Discrepan�•Indication Space <br /> Quanlil ResetsidueIN, vi V` a166renI Nmby❑AaAll <br /> rti wfl ' k4} civi <br /> ujar;liii+ <br /> lift 18b.Allemale Fa6tily(or Generator) U.S.FPA ID Number <br /> J <br /> U <br /> i� FaGfrly's Phone: <br /> W 18r Signahur.•nlAlh•rr!ate Facility lorGinprafar) Month Day Year <br /> 7 <br /> z1 <br /> v5 19 Hazardous Waste Report Management Method Codes(i e,codes for hazardous waste treatment.disposal,and recycling systems) <br /> LU <br /> t ffw-1=v z. H141 H141 4' H1 41 XM <br /> 20.Designated Facility Ovmeror Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1B <br /> Prinled/Typed Name Signature Pd th y v a <br /> M6 wdlmo- <br /> EPA Form 8700.22(Rev.12-17) Previous editions are obsolete. SIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />