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Please print Or type. Form A roved OMB No 2050-00 GENERATOR 1 ).- UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number CACZ0002-5-9 4 32- 2. Page 1 of I 3. Emergengy,Re4p,og472n146.1 , , .., 4 )17 ...., 4. Mp,31(cot TAckinglturab t, no 4 15 61) 3 3 GBF - ni Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) p.0.130 80818 S:VOCKTD/J 1-0(31cTIGS L-LC, sp)(,Krom t-c-xvtirtc-i> LL.........,,,.....1-0.--cgar--1-4,44.--AbLe rist s;,-irsonviii.> SC.2.9480 4 tSct c-Ak 6RAL•rt5.-.R. (;r: Ge-iPa t-- 11 1 0 C;PC)) 21:34 - GO 1 k I '6TocK -to k). ceis 9S-2-0 t Transporter 1 Company Name U.S. EPA ID Number kg.C, Ek)v tRou44,-E-NTAL S_ERU tc.e.; I mc. I CAR 0:)00-301 Li. Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number U °L°, gEVA DA hwY /5, II lAtLE's S oF SA-TTY 15 60tv-r-ni; N EvA OA cgl 003 Facility's Pnonc. (toc-3) 2 .`i-:-Ylii S I ivvr3-3a--,i 00c0 Oa 9b. U.S DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit Ft,' and Packing Group (if any)) No. Type Quantity Wt.Nol. 13. Waste Codes l' PDX) R.c.(2A IkA2AROC‘AS wAsre 5oLiD („D % EsEi-- 0:›VrAkh 114 ATE D Soli) e3C).6 DIA 2%00 13 352 - - 2. Jr Rc4„ Vk AzARDot-ts wAsTE got- L O (OlLy Deilczks) 001, hM 0150 1' r INDM Rr.,RA RAZAROcus wAs-rE /,.1 akA om 0-so° G. 343- (34A-Ttc< wt:rvt OlEsEL) 00(0 4. Special Handling Instructions and Additional Information / po tt. 1 tsg- L414 i 1161) Clo u-S 300 -7%‘z.0 &( 55 152)07ova 300 -'2 7 gInG otxS's Dm 963)01o111S-7 0-2-411c) doc sCoA4 GENERATOR'SIOFFEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and 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 I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if tam a large quantity generator) or (b) (if I am as mall quan ' enerator) is true. Generator's)0 or's Printed/Typ 1,1k-iNi ame Signature Month Day Year I (T)71 .- I 1 1 I 21 I:- M International Shipments Import to U.S. Export from U.S. Port of entry/exit: Transporter signature (for exports only): Date leaving U.S TRANSPORTER Transporter Acknowledgment of Receipt of Materials Tran loner 1 Printed/Typed Natiner Sigyjure 1/1 Month Day Year .1- - 1.- -I 7----- I II 2 1 Z.Z. nsporter 2 Printed/Typed Name Signature Month Day Year I I I -4--- DESIGNATED FACILITY -0- Discrepancy 18a. Discrepancy Indication Space LI]D Quantity Type Residue Partial Rejection El]Full Rejection Manifest Reference Number. 18b, Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I 18c. Signature of Alternate Facility (or Generator) Month Day Year I I Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. 2 3 4 Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a Printedfryped Name Signature Month Day Year I I I I EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM