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a �+� r.Generator ID Number Form Approved.OMB No.20.50-0039 <br /> d� „ynrzoous �-AL�J 1184�yy 2.Page 1 of I.Emergenty Response Phone 4.Manifest Tracking Number <br /> y rE M/'tNrFEs7 1MXj-j4'�144V <br /> �--fors Name and Mailing AddressA`� VV 0 2 5 5 JJ K <br /> 12(A E MAIN S7 Generators Site Address(it different than mailing address) <br /> S 1 UC;K 1 Ufd.(:A %20t, <br /> va-rants-6 -ii-iva <br /> Generator's Phone: <br /> 6.Transporter I <br /> Company Name <br /> AMERIt:AW VAlL�Y WA,SIE C)t1,IN(; <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name CAFt(1f1[)2723012 <br /> b I EkII SI'tC;iAL I Y WAS I EU. .i IONS,UVC <br /> U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address R�VSUOO7 i OW24 <br /> tial l%tNTUt(Y VIRUNtAIALiVIGFAl VF <br /> 2045 i'E%w jig DR. 1 U.S.EPA ID Number Rdl/fl4f(1)RraS tea <br /> rcrrntt-�^r,t4V aaaaa <br /> Fadliys Phone: <br /> ga. 9b.U.S.DOT Descripbon(including Proper Shipping Name,Hazard Class,ID Number, <br /> HM and Packing Group(it any)) 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> O 1. FtCr P)Atlttl3 FIA7AF`fMi1IR WArTr !f{Hrfi1 hl f) 4 tN;1i1 No. Type Quantity WtNol. UCIQ; 342 <br /> W <br /> W 2. <br /> (9 <br /> 3. <br /> 4. <br /> 14.SPedal Handling Instructions and Additional Information <br /> I ki7FILF# UU t_ifilr4ttiPdli:5UJ7)iiF. I-HU# 1%1 <br /> EN1 RkalN(:Y(A)WA I: FAAi3Y <br /> 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, <br /> 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 I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(d I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generatoes/OHeror's Printed/ryped Name Signature <br /> ---- —, .. Month pay ypar� <br /> 16.International Shipments 61 / <br /> Z ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Prim ed/ryped Name <br /> Signature <br /> Months Qay Year <br /> Z Transporter 2 Printed/ryped Name <br /> Signature <br /> Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑Quantity ❑Type <br /> ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate Fadlity(or Generator) Manifest Reference Number: <br /> J <br /> V U.S.EPA ID Number <br /> LL Faciliys Phone: <br /> W 18c.Signature of Altemale Fadlity(or Generator) <br /> a <br /> � Month Day Year <br /> 1. 2. wastreatment.W 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treaent,disposal,and recycling systems) <br /> � <br /> 3. Notice:State of California requires <br /> 20.Designated Fadrry Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a generator to photocopy and m a i I to <br /> PnntedlTypedName DTSC With 30 days: <br /> Signature <br /> P.O Box 400 <br /> EPA Form 8700-22(Rev.12.171 PrevioUS editions are obsolete. <br /> Sacramento,CA 95812-0400 <br /> UhNERATOR'S INITIAL COPY <br />