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?lease print or We. Form Approved.tafu8 Na.2054-0039 <br /> ONIFORM HATr4RDfJUS 1.Generator ID Number 2.Pape 1 of 3.Emergeroey Res onse!hone 4.MariVestTracking Num bor <br /> WASTE M011F£ST A {} I .888-6�k 022071064 JJ K <br /> Adaress enamors t{:p f i man mailing Daresay <br /> e-'603 Mah St 2,650 N MaCarlhur Dr <br /> Irvine CA X32614 Tracy CA 25376 <br /> Generator's Phone: 9 4 9 8 9 1 - 9026 <br /> 6. (artspprter 1 Compo a U.S,EPA I Number <br /> ',�IH)n,n�t:r'vmIto��tk.%Its. CARD 0 0 2 1 7 5 1 3 <br /> T Transporter 2 CAmpany Name U.S.EPAID Number <br /> 8.7e5r�gd.Filtrp�larpe and SdeAddress U.S.EPA IQ Number <br /> Dioa,W on CA 92316 <br /> Fw1t's Phone: .•r 421-Wl A [} 4 4 $ f <br /> ga. 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,IQ Number. 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI.Nol. <br /> 1Mn' t �2lilgjv q r .s, ;' D— .inn,MW12re) <br /> 2 2, <br /> W <br /> C7 <br /> 3. <br /> 14,Special Handling Instructions and Addillonal Informationit is s : .a- i� , <br /> 15. GENERATOR'SOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described above by the proper slMppiing name,and are class4ed,packaged, <br /> marked and•labeledfplacarded,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 cw wm Io the terms of the attached EPA Acknowledgment of Consent <br /> I certify that ttre waste m rrimixation statement Identified In 40 CFR 282.27(ay(if I am a large quantity generator)or(b),11 am a small quantity generator)Is bus, <br /> Generalp+slt7fferar's Prin1cdfTypod ame Sign l� Day Year <br /> .� k70 1 �T� <br /> 16-Internatfonaf 81hipmenis 1114.1 to U S. ❑Export from U. . Port of entry/exit. <br /> tTransporter signature(far exports oNy): Date leaving U.S.: <br /> nd 17.TransporterAeknewledgmanlof Receipt of Materials <br /> Trans Wdr7yped ' Signa j Month Day Year <br /> N i r <br /> ransporter 2 nta8 pe Name slgnatura Month Qay ear <br /> 18.Discrepancy <br /> 1&a.Discrepancy Indlcarson Space ❑ Quantity ❑Tye ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Numhsr. <br /> 18b.Atomic Facility(or Generator) U.S.EPA ID Number <br /> 3 <br /> u <br /> U. Fa6lity's Phone: <br /> 18e.Signature of Alto mate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes far hazardous v+sste treatment,disposal,and recycling systems) <br /> C 1 2. 3. 4. <br /> rlle1naled Faeifty Owner or Operator:Certification of recelpt of hazardous mate rials covered by the manifest except as nftd in Item 18a <br /> yped Name 86gnature Month Day Year <br /> EPA Form 8700-22(Rev. 12.17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />