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DISC. 0t 35 7'_ 133 4' <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST CAL000353037 1 856-333-9222 003447053 FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Dole Pacukaged Foods LLC - Stock-ton 1668 El 21nal Dr <br /> 7916 5ellevue Rd Stockton, CA 95205 <br /> Atwater, CA 95301 <br /> Generator's Phone: ?n q S S R—564 3 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Advanced Chemical Transport CARD00070540 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Rivezbank Oil Trans¢er,LLC <br /> 5300 Claus Road <br /> Riverbank, CA 95367 <br /> Facility's Phone: 209-863-8181 CAL000190816 <br /> ga 91b.U.S.OOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity WIJVoI. 13.Waste Codes <br /> I. Bon RCRA Hazardous Waste, Liquid (Oil) 221 <br /> t DG <br /> W <br /> lJJ2. Njee eA 4A 7#412 Orv1 � F_ b <br /> L/4TL, vr p <br /> CD OO.tlD /j ZI <br /> ' ) <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Froiect Zumber: CV01041-04 <br /> tt I ,c,-S e/s 6 012-o 01 <br /> ,2).2y_57 Ir 6/r eoQ-oe�z.mo3 <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 certity that the contents of this consignment conform to the terms of the attached EPAAdmowledgment of Consent. <br /> I certify that the waste minimization statemen 'dentified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a all quantity generator)is true. <br /> eratoesleror's Printed/Typ ame c �Igflatyre Month Day ear <br /> —J! 16.International Shipments— <br /> P— <br /> hipmentsZ ❑Import to U.S. ❑Export from U.S. Port of entry/exit <br /> Transporter si nature for exports only): Date leaving U.S.: <br /> LU 17.Transporter Acknowledgment of Receipt of Materials <br /> w Tra er 1 rinted/Typed Nam Signa n ay Year <br /> .. <br /> CL <br /> O6 r <br /> za Transporter 2 Printed/Typed Name A09nature Month Day ear <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> Q <br /> LL <br /> Facilitys Phone: <br /> W 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> 19.Hazardous Waste Report Management Method Codes i.e.,codes for hazardous waste treatment,disposal,and <br /> � po g ( po recycling systems) <br /> p I //// Z 3. 4. <br /> &/V/ <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prmted/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10737.0352 <br />