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Blease printjor type. <br /> Form Approved.DMB No.2050-0039 <br /> i.Generator ID Number 2.Page 1 Tf3,.Emergency Response Phone 4.Manifest Tracking Number <br /> U W STE MIFORM AN ESOUS �d9 "1•�r'1� c 1"" 89399 JJK <br /> 5.Generalor's Name and Mailing Address Generatohs Site Address(if different than mailing address) <br /> LW W SiTORAGE-ACA4elr''Q 23265 N Hill 99 <br /> P.O. SM230 ACAMPO,CA <br /> ACAMPID.CA WIM <br /> Generators Phorixg-wIrm Transporter 1 Company Name U.S,EPA ID Number <br /> 7 Transporter 2 Company Name I Number <br /> . <br /> 8.Designated Facility Name and Site Address .S. Number <br /> RAM�3S !° Dt�..;:... . ._. ,wR���+'�., ; RNC'. <br /> 1515 SOLMI"R fw. <br /> VMST SA,CRANem.CA 9M1 By <br /> Facility's Phone:-416-571-6747 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13,Waste Codes' <br /> HM and Packing Group(4 any)) No. Type Quantity Wt,rvol. <br /> I. MON RCRA RAZARDOUS WASTE SOUD (OIL DEBRIS) P 352 <br /> W <br /> 3. <br /> i <br /> 4. <br /> 14.Special Handling Instructions and Additional Information S,,'-pc 2 l <br /> ]Bt)PROFiL ES RES"2►-14 EMMA 71 <br /> HA©NDy�`'�EER���'SpTC]/�ByE�y�TRAMM AND USE APPRaVED PPE. <br /> 4-R. Y1o11VTRAMT ' RAhM E�MENTAL SERIES <br /> 16. GgNERATOR'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 labekedfplacarded,and are in all respects in proper condition for transport according to applicable intemalionaland national governmental regu#afions.If exporl shipment and l am the Primary <br /> Exporter,i certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgmant 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 /> GeneratorslOfferor's Printecirryped Name f Signature, Month Day Year <br /> 16.International Shipments <br /> F, ❑Import to U.S. ❑Export from U.S. Port of entrylexW <br /> Transporter signature{far exports only): Date leaving U.S., <br /> ir 17.Transporter Acknowledgment of Receipt of Materials <br /> w Month Day Year <br /> Transporter 1 Printedffyped NameSignature <br /> .1Gi r/ Month Days Year <br /> Z Transporter 2 Printed/Typed'Name / Signature <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> H 18b,Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: Month Day Year <br /> w 1B Signature of Alternate Facility(or Generator) <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1_ 2. 3. 4. <br /> 4IL-1 � <br /> 20.Designated Facility Owner or Operator;Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedfryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev,12-17) revious editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />