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if 11111111111111111111 Please punt or type. Form Approved.OMB ND-2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number F-Pale 1 of 3.Emergency Response Phpne 4.Manliest Tracking Number WASTE MANIFEST 014029096 F L E 5.Generator's Name and Mailing Address Generalors Silo Address(if differen€than mailing address) ..T::Gn•iaILL ,i . . _ .,4Cr 8' ?►: .. 4953 pacific Avenue, Space 425 4950 PacifiC Avenue Generator's Phone- c+ ',r ,n• a= I' r. q9207 6,Transporter 1 Company Name U.S.EPA!D Number 7.Transporter 2 Company Name U-S-EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number X130 c. 13 t re Pt Facility's Phone:.: ga 9b.U.S-DOT Description(including Proper Shipping Name,Hazzard Class,ID Number, 10.Containers 11.Total 12.Unit NM and Packing Group(if any)) No Type Quantity WI.Nol. 13.Waste Curies 1: � C+�i.Vrryly 2. LU 0 — 3- ----------- 4• 14.Special Handling Instructions and Additional information `I � 13• v 15. GEN ERATOWWOF FERO R'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above proper shipping name,and are classified,packaged, marked and labeleftlacarded,and are in aH respects in proper condition for transport according to applicable international llonal govern tat re tat ons.It export shipment and I am the Primary Expuder,I certify that The contents of this consignment conform to the terms of the attached EPA Acknowledgment of Cc ni. certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b) am a small quanpt end r)is Ince. Gene slDfferors Printedl'yped Name Signature,;,: e.r �I y ❑f �i�.:a Mnnlh Day Year ,J F3 16.intemational Shipments F ❑Import to U.S. ❑Export Irom U.5. Port of ntrylexit: ? Transporter signature(for exports only): 1 ❑ate ving U. .: ac 17.Transporter Acknowledgment of Receipt of kdaterials i LU Transporter 1 PrinWdfTy*Name Signa ro Month Day Year Inthnny Ma6(on X Transport9{2 PrintedlTyped Name Signature s/7 Month Day Year/ 1 0r, 1 a.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Reed r, Ie Fult Re ciion Manifest Reference Number. 18b-Alternate Facility,(w Generator) U.S.EPA ID Number rai Facilitys Phow: W lac.Signature of Alternate Facility(or Generator) Month Day Year a M 19-Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) in 0 1. 2. 3. 14. fh L[[ 20.Designated Facility Owner or Operator:Cer6 tion of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/T ped Namelj V Signature .4onti Day Year EPA f=orm 8700-22(Rev,12-17) Previous edition obsolete. DESIGNATE ACILITY TO EPA's e-MANIFFS SYSTEM