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Please print or type. . ro ed. OMB No. 2050-0039
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<br />UNIFORM HAZARDOUS
<br />WASTE MANIFEST
<br />1. Generator ID Number • .
<br />CAC0031.32933 ! ' .
<br />2. Page fof
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<br />3. Emergeney Response Phone
<br />-877-256426,5 •
<br />4. Manifest Trarldng Number
<br />. 0 2 1 3 6 0 609.
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<br />5. Generator's Name and Mailing Address . I .. .• '*--,i' ."'' .. ,. GeriereloilItteAddrititif different than malting address)
<br />, tallIstillepTIALIngi . . 149E121 .436611 . . •
<br />MOW CA 94543 • ' • • , ., , •
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<br />Generator's Phoner0741041036,,::„ ,...., .o
<br />Transporter 1 CompemiName.. ...,„-.,! ft • : : • . .• , ' .. ••,U.S. EpA ID Number . .. - :-..n . •. •;•;..:
<br />Ponder inikoniiiirital Strvices ' • • .f.k.-...- • • - , - .1cMitiovi 50737 . .
<br />iensporter 2 C.ornpany Name •U.S. EPA ID Number
<br />US
<br />Fadlity's
<br />Ft Designated
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<br />Facility Name and Re Address ..;
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<br />11 ' - Soulliof Beatty - 7' • i - • i
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<br />Phone: .o.„,pt,&;;:nLsk.f.1) -- ,...... :' f'... . ' -I.: ..,....' ..:1100,2251-3943: 4: - • .
<br />U.S. EPA ID Number
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<br />N V T0 04,11 0 0 00. • •
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<br />ga. ob. us .,•VoiliVsapti4iibMiciiiiggap‘i;*04Nitri; iiiiiicfaiik16 VI*, - 4' '?"'' '"' :'.'''''•'. ".'' '1.0...riiitilnalet. .".‘ .. 1i :iota( - - '.ii-diii IS. te as
<br />NM • and 1'069 Gf60 Of any)) . ,
<br />14101/110 1111.40.kie ( P4.01001.1101$1100...- ., .; :r. 11 . ....,..
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<br />14. S_ pedal liapOlg In .sbuctlais and Additional infonnalion • . • .
<br />11 iiiMM7:
<br />PO4. 750211. ' - " . ... ,
<br />-• • . • .. jObi. 2144204.
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<br />• GENERATCRI/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descrtised above by the proper shipping name, ard are classified, patiraged,
<br />marked.and labeled/placarded:and are In al respects in proper conditionfor transport accerding to applicable International and national governmental regulations:If export shipment and tam the Primary
<br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment ef Consent. . .
<br />I certify that the waste minimization statement identified In 40 CFR 202.27(a) (If I am a large quantity generator) or (b) (ill am a small quantity generator) Is true.
<br />Generator'srOfferor's Printed/Typed Name . . SIgneture•-7 -___-..? _.,-.-;.--- •
<br />Month Day Year
<br />. 6 Rem y 4 i g 14 1 la C. -kJ IS .14/.14 i: ,--eis l'Alcti .f.,..ve . .•;,-• . . 1081 /9 1 41
<br />..,:_i International Shipments . . • Import to U.S. • Bmort from US. • 'Port of entry/exit •
<br />..Transporter eignature.(for exportS only): ,. . • . Date leaving U.&
<br />IX TraniparterAdoenvIedg ment of ReCelpt of Materials ' ,......._ . TRANSPORT! . , Lelsnotdee . 4.• ' • I
<br />Tirtilmisxsaporterewy1 Pdgled/Typed Nam_. - Signature- Mo.' . ',Day Year
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<br />T18raan. sppiordaerep2a . . Signature . . ' ' • Month Day. Year
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<br />helyiilledirindicaYPedtion Space . Quantity L_E Type LI , .
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<br />! 0Paitial:Rejection •
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<br />Residue
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<br />., .,L,-1 Full Rejection
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<br />, Manifest Refetence.Numben
<br />18b.. Alternate Facility (Or Generatre)...! - .-1 U.S. EPA ID Number .. •
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<br />Facitity's Phone: • .
<br />1 tic. Signature of Alternate Fealty ior Generator) . .
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<br />. Month Day Year
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<br /> Hazardous Waste ReportManagement Method Codes (.e., codes for hazardous waste treatment, disposal, and recycting Systems)
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<br />Designated Facility or Operator; Certification of receipt of hazardous materials coveied by the manifest except as nded in item 18a .
<br />Printed/Typed Name /r, . • • Signature . -.,*.-----::: . .
<br />.. .. mow: ... ay ,.. year •
<br />'Oak/ a ' . ' ". " ' " ' '• il i • : i' 1 e. .1
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<br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. •
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