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c�o9272c� <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11.Generator ID Numbsr 2-Page 1 of 3 Emergency Response Phone 4.Ma_ T111490`469 l <br /> WASTE MANIFEST r L E <br /> 5.Genaratofs Nacosra d�rygaiiid691 Genaratu�s Site Address(if dl>Tarent than mailing address) <br /> LLi�33�331/v5�.1 H[1d <br /> L�� 5242 <br /> CA X5242 <br /> Generator's Phone: 209'333-OM Xt 2745 2096333-"W Xt Z743 <br /> 6.Transporter 1 many Name IncRW U.S.EPA ID Number <br /> FLR00016SZ03 <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> 8-Da5 <br /> t" me +nn I F a rasaWd Tmrw r LOS Amies LLC U.S.EPA ID Number <br /> Angfti CA 9058 <br /> Facllily s Phone: 323-277-2300 CAD 0 5 0 8 0 6 8 5 0 <br /> go. 9b.U.S.DOT Descdptlan(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM 1.and Packing Group(if any)) <br /> No. Type Quantity Wt./Vol. 13.Waste Codes <br /> 7 <br /> O �R PC$S�q� / <br /> 31 <br /> LU <br /> 2 K <br /> 3. <br /> 4- <br /> 14. 1 <br /> Sp@c I I df r I s bns and Ad Itio I Inf�rn" <br /> � 19,V (& Emergency Response Contact: Emerefd Transformer <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that Mie 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 contents of this consignment conform to the terms of the attached EPAAcknowledgment 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(bj(If[am a small quantity Nrieralor)is true. <br /> Ganaratarst0ffaror's PrinledlTyped Name / < SI alure Day Year <br /> -A <br /> j 16. nlar allDnai Shipments <br /> r !? <br /> I- D Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> 3 Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Tra sporler Pdntedffyped Namen re Mo Day Y <br /> rd <br /> aTr ns rte 2 PrimledlTyped Name USig lure Month D ea <br /> F <br /> 18.Discrepancy <br /> 189.Discre nay Indication Space rantit <br /> f a � �, 4 Lt WL'3151Wr Jection a <br /> 'L 'gv \ AMA L. W • <br /> f du <br /> 18b.Allemate Facility(or Generator) �310J m <br /> U <br /> LL Faculty's Phone: <br /> W Tec.Signalure❑f Allernale Facllily(or Generator) Month pay Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Lu <br /> 1 H141 12. 3. 4, <br /> 20.0ealgnated FacilityOvneror Operator:Cartif lion of receipt of hazardous materials covered by the manifest except as noted in I m 18a <br /> Priniedrfyped Name Signature or <br /> IT <br /> Y <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. SIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />