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9..; 11111111111111111 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter,) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST i P, '75774'6F,9 011386223 FLE <br /> 5 Genemlor's Name and Mailing Address Generator's Site Address(i di erent than mailing address) <br /> Vic.1;Lr)FYI S fit ct"C't '#1r'kf-i"t:k rr'iC:i {� :•t <br /> 2094761962 4950 Pacific Avem%e Soaee 425 4350 Pacific Avenue <br /> GeneratoesPhone: a ock on, A 2Y�f 3Ga ;<Gai1. CA �-1520T <br /> Transporter Company Name U.S.EPA ID Number <br /> i" Gtr 1E M4S;0oji",110 2A <br /> 7 Transporter 2 Company Name U.S.EPA 10 Number <br /> Woridwide Recuvery avyfGemE CAR000175422 <br /> 8 Designated Facility Name and Site Address <br /> f U 10 a ti-C' I I C U.S.EPA ID Number <br /> '710 E. 13th Street <br /> 'euma. A7 85-H5 <br /> Faci it's Phone: 9-28642B938 1AZR00051.5924 <br /> ga. 96.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No Type Ouanpty WLNoI <br /> 'Non RCRA I-lazardau=_ waste. Ii(3uid (�:f;3cs, 1 DF 00085 P <br /> 00 Lotions) . <br /> Z 2 <br /> w <br /> 3 <br /> 4. <br /> F-- <br /> ,4,Special Handling Instructions and Additional Information i 1 L)-Jtr1i :`at a t e R e i m at,'d L i O fx i d-i) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper ship,g name,and are classified,packaged, <br /> marked and iabelediplacarded,and are in all respects in proper condition for transport according to applicable international and nationt governmental ragulatio .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 /> 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 3/m q miry genera �s ue. <br /> en rotor' eror s rinte yped ame Signature 5 RCE r e O�Ib i i m i t P on ay ear <br /> 03 05 =019 <br /> 1 16 Intemational S mants <br /> r <br /> Zi✓Import to U.S. ED Expert from U.S Po"of !T, 4: <br /> DatleaTransporter signature for exports onl _. _...__---. ....... _._..___.___.....�.� <br /> W 17.Transporter Acknowiedgment of Receipt of Materials <br /> O Transporter 1 PrintedfTyped Name St ure Month ay Year <br /> d.W Aflt anv MackI AY.,i -"& 03 05 019 <br /> Z Tran nT�d c' l�zG�v� ✓CZ• �. Month aY <br /> Year <br /> DS <br /> 18 Discrepancy f= <br /> 18a,Discrepancy Indication Space <br /> t� Quantity ❑Type ❑Residue F1 Partial Rejection Q Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator; <br /> U.S..EPA ID Number <br /> J <br /> U <br /> a <br /> Fadli s Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Oay Year <br /> Q <br /> Z <br /> H19.Hazardcus''Alaste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1 2 <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PNntedffyped Nam a e Month DaLl iLtlo t A.,cl A C-1 V1 y Ye <br /> 14 <br /> ev �y <br /> EPA Form 8700-22( .3-05j Previoudt t <br /> s eons are obsolete. I <br /> J I t�5i"' tATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />