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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB N450,flqP39 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST A L°a '6 ` 0" i`b ,' 1 U <br /> 5 Generator's NaeI�vT' " r u tATHRf3P d aGenerator's Site Address(if different than mailing address) <br /> iJ <br /> cI�Ii' <br /> P.U.BOX 8468 <br /> gMXXTON CA 95208 702 MRCY Pi�."11itY <br /> Generator's Phone: X9 993.6696 i.ATHROP CA <br /> 6.Transporter 1 Companya U.S.EPA ID Number <br /> MIN" IEWAL,SERVICES, 7 7036 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated FaCiJity Name and Site Address U.S.EPA ID Number <br /> 2730 E 13TH ST <br /> A7 65365 'AZR000515924 <br /> Facility's Phone: (Cag1144'w? <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> IKA't 1•i'L.1=A r r d.Ja, j"- WASTE z LID(PAPER FILf FIRS) '�2 <br /> Qa <br /> a <br /> z 2. <br /> LU <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY WNTACT:CHEMTREC 1-800-424-9300 WOES TERMiNAL:CERES CS *PROFWE f#9BI ;1624 2 3AW608 PAPEP <br /> FILTERS* APPROPRIATE PPE aEQWPiMIENT <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 contents 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 I am a small quantity generator)is true. <br /> 7s/Offerors PrintedlTyped Name Signature Month Day Year <br /> J 16.International Shipments Export from U.S. Port of entry/exit: <br /> /exit: <br /> Z 11 Import to U.S. ❑ p ry <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> LW 17.Transporter Acknowledgment of Receipt of Materials <br /> L <br /> Transporter 1 Printed/Typed Name / Signature Month Day Year <br /> Oarv' <br /> zQ Transporter 2 P ted/Typed Name Signature Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑ ❑Full Rejection <br /> yp El Partial Rejection I <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> 1 <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 0 <br /> N 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. J <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />