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t. <br /> Please print or type.(Form designed for use on elite(12=pitch)typewriter.) e j <br /> to Form Approved OMB No'.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3 Emergency Response Ph 4.Manifest Tracking Number <br /> WASTE MANIFEST �. A L 0,0 s ;0 42 . I �f��s:�� i �" F � <br /> JJK <br /> 5.Generator �INName aqd Ma/IingAddress Generator's Sitedd ('rfd Brent than mailing address) <br /> 14'1,01 At <br /> Pry-304 <br /> Generator's Phone: <br /> 6•Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.DealHated FaciliName and Site Address U.S.EPA ID Number <br /> I 1-Ni,I'('Kft.;I,:INQ <br /> 2000 N, 1.AtV1l I y 'TRETT <br /> Facility's Phone: 7 . <br /> 9a. 913.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)) No. Quantity Wt.Nol. 13.Waste Codes <br /> 1 Iff at <br /> E r <br /> £>. <br /> Al <br /> LU <br /> W z. WASTE3 <br /> RECYCLING SAA HAS BEEN UALIFIED FOR <br /> DBA A WORLD AT MENNQ <br /> -�._. <br /> 3CALIFORNIA.THIS FACILITY I[ITY I!o COMPTON, <br /> PERM RS TO RECEI H' THE NECESSARY <br /> OU <br /> QUALIFIED. YOUR <br /> EP Wqy STREAM AS <br /> R <br /> a. UBOW13352. <br /> i <br /> 14.Special Handling Instructions and Additional Information <br /> I_ <br /> rs. n{r ,,. of r r _ , q 9 f <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately describei dove by=toe proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and nationarg emmenta(regulations.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 EPAAcknowledgment of Consept:-' <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(4(IfI am a small qua generator)is true. <br /> Generator's/Q(fe-'VPnntedfT edd Ni Signatura.., Month Day Year <br /> mJ 16,Internatiohalvents ,.p> <br /> F- ❑ I Mil <br /> Impart to :S" 'Export fron5"U. ;,Port of entry/exit. <br /> Z Transporter signature(for exports only):. . -, Date leaving U.S. <br /> w 17.Transporter Acknowledgment of Receipt of Materials el <br /> . <br /> W Transporter 1 Printed/ryped Name gbature Month Day . Year <br /> O - <br /> j. <br /> d a` .o 3 »* /i 3..^'r.w:. P / 7 d�s6+'�'aap'uwwa«+v+" - - rt�y�x 7 F <br /> Q ransporter 2 Printed/Typed Name Signature Month Day Year <br /> is <br /> 18.Discrepancy <br /> i <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue j ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Num <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J _ <br /> N. Facility's Phone: <br /> W 18c.Signature of Alternate Fatyerator)Z Month Day Year <br /> W19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 11 <br /> J ' $i 2 3. 4 <br /> 70.Designated Facili Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature <br /> Month Day Year <br /> iv <br /> -. �d <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete.' DESIGNATED FACILITY TO GEhERATOtt <br /> I <br />