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P se pent <br /> 0077676528K6 <br /> UNI I-Generator ID Number 7'. Form Approved.OMB No.2050-0039 <br /> 2.Page of 3. h." 4. <br /> i Number <br /> WASTE MANIFE57 <br /> 5,Generator's Name a Mai 007MRS�o SKS <br /> SA F E. Y-,v,i F.F' T.,V'T 7 Ge r`$Slt�e�l �Ts I S <br /> 1'(�different thc��fr7iNlrq.addrpss) <br /> Ganer"s Phone 2 0 5 45-`10 11.1 <br /> ................. <br /> I�I i., _3 <br /> F, <br /> 7,Transporter 2 Comparry Name <br /> U.S.E-0 Number <br /> 8.Designated Fac lily......... ....... <br /> Name and Site Address i: le <br /> S]i: j GRI_IFOWIA — r-r-MW Number <br /> 6860 "1 <br /> 5 10 �5 4 v CA 94560 <br /> Facilll a Phone. <br /> ga. 9b-U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID NL'rnber, <br /> Him and Packing Group(if any)) 10,Coatainers 11,Total <br /> jEj[ IV21-Unit <br /> No- Type Quantity V 13,Waste Codes <br /> 1. W�01--RUPA HAZARDOUS W4 IgUTD RAN, <br /> 16 OlLi <br /> 00 1 <br /> LU <br /> Z2. <br /> LL1 <br /> 3. <br /> 4. <br /> -,-4 -fat Handing InstructionsandAdditionallnfomranon TSD;EVO <br /> �,Ptalrec! by <br /> an initial trans autho,fri %0 <br /> -- 50r'ter to add or substitute additional transporter a <br /> 15. GENERATOR'&OFFEROR'S CE s beha 1 f <br /> N: I hereby declare that the contents of this oDrisignment are Tu"Y and a=rat*described above by the Proper shipOng name,and are class[fed,packaged, <br /> marked and lab&d/placarded,and are in 8.11 respects in proper condition for transport according 10 applicable internabGrial and national governmental regulations,ft export shipment and f am the Pdrnary <br /> Exporter.I oe"that the contents of this consignment conform to the tam of the aftad*d EPAA&nowW <br /> I mrffy that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quanft genera gment of Consent <br /> tDr)or(b)(if I am a small quantity generator)is true. <br /> GBrierabr'sl0bror's Printe(Fype-d Name ............. <br /> Sign refL <br /> Month—My Year <br /> AAA� 111161111 <br /> ternational Shipments <br /> 76.i; Lj I*Z(A 12.1 <br /> ❑Import to U.S. ❑Export from U.S. Port of entry I le 11 x I i t. <br /> Transporter signature(for exports 0") <br /> CC 17.Transporter AcknaMmonehil of Recalipt of Materials <br /> LU <br /> Tra I Printedrryp-d Name <br /> Signature <br /> Md, <br /> Month Day Year <br /> Transporter 2 Pr[nWffyped Name <br /> 18.Discrepancy signature Month Day Year <br /> I Sa-Discrepancy Indication Spam ❑ Quantity0 Type ❑Residue ❑Partial Rejection Rejection <br /> ejection <br /> I ab-Artsmate t-ac"Ky(Dr Generator) <br /> -J U.S.EPA ID Number <br /> Facility's Phone: <br /> ju 18c.Signature of Altep r Pate r-adlity tor Generator) <br /> Month <br /> DayYear <br /> 19.Hazardous Waste Report Mana hazardous waste treatment disposal,and recycling systems) <br /> C <br /> aemerwA Method des(i.e..codes for Co2- 3tL*3z� F— 7i- <br /> 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br /> Printed[Typed Name <br /> 0 Si�n—ature �D a—r <br /> 17; 1 _ I <br /> EPA Form 8700-22�Ray.12-jZ) Previous i'onsar obsolete, <br /> 1 .7 DESIGNfED FACILITY TO I-5-e--M4N IFEST'SYST& <br />