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Please print or type, Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS ' GeneratGrlD Number 2-Page 1 of ,�El, Res rise Phone A.MIAT f. t.Tra <br /> swflaill <br /> WASTE MANIFEST GAILOW;;1F = �' � 1 JJ K <br /> 5.Generators Namear�t M€tiEin Generatof's Site Address(if different Than mailing address) <br /> ����,ORy�T4��� <br /> pec N.TRACY BLwD <br /> TR-kC r CA 963f34 <br /> Generator's Phone: 209•B3dw3w--, <br /> 6.Transporter 1 Compahy.Name <br /> N•dh1A lrJ Lp1ARFjr,lTl(. U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.FPA Ip Number <br /> 8J #L and Site Address U.S.EPA Uumber <br /> Faclty s PhpnP t7 t1. $'dS <br /> ga. 9b-U.S.DOT Description{including Proper Shipping Name,Hazard Glass,ID Number, 10.Containers 11.Total 12,Unit <br /> HM and Packing Group(if any)) No. Type Quantily Wl.Nol. 13-Waste Codes <br /> .e 1•t'01Nl ft LNN* I V-ARDOUG uWASIt ,;Otjo i{pfi 7t"urt#afft� <br /> o F Fd,n <br /> txf <br /> 14 <br /> a z. <br /> 114,Special Harldl6>g lnstrudions and Additional Information <br /> +Vv ft GLOVES: �Lff.'CJ 13 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare Etat the.contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeiedlplacarded,and are in all respects in proper condition..for transport aoeording to applicable international and national governmental regulalions-If export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this oonsignmenl Conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CPR 262.27(a)of I am a large quantity generalor)or(b)(if I am a small quantity generator)is true. <br /> GenerglorslOfferoes PrintedlTyped Name Signature Month Day Yea <br /> r,a'1, r iCi JF, f,t, - <br /> 16.Intematiomi Shipments <br /> ❑Import ❑Export from U.S Port of en (exit: <br /> ? Transporter signature{for exports only)7 U S Date leaving U.S.: <br /> W 17.Transporter Ackreawle igmenl of Receipt of Materiais <br /> Lu <br /> Transporter 1 Pn yped Nam $i nature !r <br /> p �1f� g �f Month Day Year <br /> 4 Transpor en.2 Printed/Fyped!lame Sdgnature Month Day Year <br /> Ia.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b,Alternate Facility for Generator) Manifest Reference Number: <br /> U.S.EPA ID Number <br /> U <br /> ex <br /> LL FaciliVs Phone: <br /> W 18c.Signature of Alternate Facility{or Generator) Month Day Year <br /> Q <br /> 19.Hazardous Waste Report Management Method Codes 04,,oodes for hazardous waste treatment•disposal,and recycling systems) <br /> uj© 1 2• 3- <br /> 4. <br /> 20-Designated Facilily Owner of operator-Certificafion of receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700.22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />