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/ / 7.? / / • Form Approved. OMB No. 2050-0039 A UNIFORM HAZARDOUS 1. Generator ID Number 2. Page lot 3. Emergency Response Phone 4. Manifest Tracking Number JJK Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) MANI).* f.-.:. . • . ,j i , : •;. %.!( , !: ti...0 Hi ,) f....t li, 'f.,'Rf.i...f.1:3()R rA-1101,,I 80X. 184o .'1, I 1.1k.;14,LN MAN fl) H 9-...A. MCI SCO CA 114 120 -1.c.,‘CKTON CA B6206 Generator's Phone: 8 ki Cl 76 1 -b UOU I Transporter 1 Company Name U.S. EPA ID Number l lit. rrsatRciNo,P . o (.1 4 g er2CompanyName01 Transport U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number l'.' ilk/ f:3130r Facility's Phone: ri f5i'll i 'f",1'.11 ' i..1 0 0 0 9a. 9b. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes NMand Packing Group (if any)) No. Type Quantity &Not. w 0 0 i .! RA1-1A,7,P,;-101 r'• . tr) Inv/ souns) , 73t,'• ....ei- R w z u.i (.7 14.S ?cis! Handling, Instr0clicry[liAdci. Ii?pail Irfornmtloii:: q 0711 I 97"1.9 II ,1/.',.• tr. 'I ' ,' ' .. ! P 1 0 rl , 15 GENERATOR'S/OFFERORS CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and tam the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if lam a large quantity generator) or (b) (ill am a small quantity generator) is true. Generator's/Ofteroris Printed/Typed Name Signature Month Day Year I I II _i 16. International Shipments Import to U.S. Export from U.S. Port of entry/exit: F- E Transporter signature (for exports only): Date lemring U.S.: F5 17. Transporter Acknowledgment of Receipt of Materials TRANSPORTE Transporter 1 Printed/Typed Name Signature Month Day Year I I I Transporter 2 Printed/Typed Name Signature Month Day Year I I I I -4- DESIGNATED FACILITY 18. Discrepancy Discrepancy Indication Space till Quantity Type Residue Partial Rejection Full RejecUon Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Name Signature Month Day Year I I I I _____. ___.... .......... ---.. EPA Form 8700-22 (Rev. 1 2-1 7) Previous editions are obsolete.