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0 i DTSC- 0133"i- 1808 <br /> F`Ase'rintor ) 'T1ALi )j� 0022-7 1 <br /> p type.(Form designed for use an 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.Manifest Tracking Number <br /> WASTE MANIFEST CAL000353037 1 866-333-9222 003-447039 FLE <br /> 5.Generatofs Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Dole Packaged Foods LLC - Stockton 1668 E1 Pinal Dr <br /> 7916 Bellevue fid Stockton, CA 95205 <br /> Atwater, CA 95301 <br /> Generator's Phone: 2 A if �i A—A A4-91 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Advanced Chemical Transport CAR000070540 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desiggnated Fadli�t Name and Site Address U.S.EPA ID Number <br /> Clenn Harbors of San Jose, LLC (San Jose Facility) <br /> 1021 Berryessa Road <br /> San Jose, CA 95133 <br /> Facility's Phone: 408-441-0962 CAD059494310 <br /> ga. 9b.U.S.DOT 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 Wt.Nnit 13.Waste Codes <br /> 1. UN11971 Baste tw rac s, Flavoring, Liquid, uu <br /> FG III, <br /> Of= 170 <br /> w <br /> LAJr �r _ .- _ <br /> 3. NA1993, Diesel Fuel, Combustible llaiquid, <br /> III G <br /> 4. <br /> 14.Special Handling Instrudiens and Additional Information seaSs 4"' <br /> (-s-L/ <br /> 1) CR441952; DL)C -C1pI,GhO ,aD3,oca4 ;Y ERG #: 127 - <br /> -�" 3) CH441960; MC - Gps/I��So/Y� <br /> Proieet Number: CB01041-02 l <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 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statemen identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is We. <br /> en ratof 0 eroesdnted/T me �_ gn Month Dav­__7e_ar <br /> 16.International Sh menTs <br /> ZImport to U.S. ❑Export from U.S. Port of entry ext <br /> Transporter signature for exports only): Date leavin U.S.: <br /> Ce 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> Tran1per�IntedfTyped Name igna on ay ear <br /> aa..� f1 Ccs <br /> N <br /> ZZ Transporter 2 Printed7Typed Name 'SignatureMonth Uay Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> a <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> v <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,� poral,and recycling systems) <br /> C 1 �`X\ 2 �`� 3 ` V 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> nled/Typed e <br /> nature � Month Day Year <br /> - A - (o D <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10744.0946 <br />