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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 1 Page I of 3 Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST I 71AL0004LI6099 1 3775772669 011385923 FLE <br /> 5 Generator's Name and Mailing Address Generators Site Address(it different than mailing address) <br /> V I C-f 0 1,1 Ek, 5 Sect-et 11 lilt:tGt-i3` 5tl�Ec-r at'#1 1-4 <br /> 2 c <br /> .094761,963 4950 Pacific Avenue. Space 425 4950 Pacific Avew.te <br /> Generator's Phone: S)tockton. CA 95207 Stockton. CA 95207 <br /> 6 Transporter I Company Name U.S.EPA V Number <br /> steriEnle sioeriailt,- wdEtE -Soilit)cins lrir- 1INS000 110924 <br /> 7 Transporter 2 Company Name U.S,EPA,ID Number <br /> 1 - `5 41 <br /> Aorldwida Recovery Sv;tem- ICAR0001f - - <br /> 8.Designated Facility Name and Site Address y It M 5 �E U.S,EPA 10 Number <br /> 21730 V, I '3th Stt-ee*t <br /> 'j A 17 15 3 11:1 <br /> Facility's Phone: '3286428938 JAZER01210515924 <br /> ga 90 U,S,DOT Description(inducling Proper Shipping Name,Hazard Class,ID Number, 10 Containers '11I.Total 12.Unit 13.Waste Codes <br /> HIM am Pack tg Group(if any)) No. Type Quantity Wt.Ajoi. <br /> 'Non IRCRA hiazai'rlous b DF 00 1071 V waste. 1101)] <br /> 0 <br /> Z 2 <br /> Lli <br /> 769 <br /> 3. <br /> 4 <br /> 14 Special Handling Instructions and Additional Information 1 i 10` 02(State Reaulated Lta',Aidiii <br /> 15. GENERATORISICIFFERORIS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described proper hipping name,and are classified,packa*, <br /> marked and labeled1piacardea,and are m all respects in proper condition for transport according to applicable internal on ahoy <br /> '"I'figulaticins.It export shipment and I am t-*Primary <br /> '$?nd national go.� <br /> e -1 )is true. <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment ofrsefii: <br /> if, <br /> I cently that the waste minimization statement identified in 40 CFR 262.27(a);Jf I am a large quarti if I am'a small quw 2/1..1 <br /> I 'S/Gff r P teOyped Name L V-aD f of L i m i t e Month Uay Year <br /> ;;z ZLAV I <br /> 16.l4lemational Shipmfnts 1-7 — \1 <br /> —n-Import to U.S. L--J Export from U.S I" entrytexil: <br /> Transporter signature for exports onl0 a feavirli!i U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter I Printed/Typed Name r on ay ear <br /> 0 <br /> 10 oil <br /> z Transporter 2 Pnnted7yped Name Signalurer- Month Lay ear <br /> 0'0')Lr�� ��- I I-0� I 2-3 119 <br /> 18 Discrepancy <br /> 77 <br /> 18.a Discrepancy Indication Space El Quantity El Type El Res;dLe ❑Partial Rejection 'uIlRejecticin <br /> 4 Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA 10 Number <br /> Fac <br /> w ,57%HPI'M-If Alternate Facility(or Generator) Month Day Year <br /> !it <br /> Z <br /> 0 <br /> ul; 19 Hazardous Waste Report Management Method Codes(i.9,codes for nazardous waste treatment,disposal,and recycling systems; <br /> UJ 1 12 3. 4. <br /> 20,Designated Facility Ov6r or Operator:Certification of receipt of hazardous materials covered by the manifest exce;Lks rioted in Item 18a <br /> Signature Month Day Year <br /> EPA Form 8700-2t(Rev.3-05) Previous editions are obsolete. 'J DE-Md-NJTED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />