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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number �[ WASTE MANIFEST CJ 0 0� 9-2,900 J is 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Via• 77R' ' ';"` OCT 3 1 N 11 AC011111f0 CA Generator's Phone: , ,cal o C` C15-224 6.Transporter 1 Company Name U.S.EPA ID N , 4 7.Transporter 2 Company Name U.S.EPA iD{Dumber 8.Designated Facility Name and Site Address may, q� � U'S-'PAID Number F �0^'111111�exr �f' Z �4 a4�g7 �41(�.� Facility's Phone: ga 9b,U.S,DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13-Waste Codes HM and Packing Group .(if -aanny)) �+ No. Type Quantity W1.Nol. LU 2. LU c� 3. 4. e 14.Special Handling instructions and Additional Information 1g" ` t Z"t f5 ru rte= 101;Z01"Ic? 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, marked and Iabeledfplacarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regutations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknow ledgment of Consent. I oeftify that the waste minimization slatement 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. GenaratotslQfier�B[i yped Name _ -._-., Signature Month Day Year J o I val Shipments F ❑Import to U.S. Export from U.S. Pori of entryloxil: z Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Trans rte€1 Printed/Typed Name Signaturef oath Day Year if � Trans atter 2 Printedffyped Name Signattua- Month Day Year fft A9, FJK 18.Discrepancy l /� 1 Ba.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fu4 Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA ID Number J_ C.1 Facility's Phone: Worth Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item.1 Be Day Year Printed ypad Name Signature Month �1,1 ( / EPA Form 8700-22(Rev.3-05) Previous editiovare obsolete. `- DF�IGNATED FACILITY TO GENERATOR