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-Apiea'se print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Annrnved OMIR-Nn 9nsn 0039 1 UNIFORM HAZARDOUS 1 Generator ID Number 2 Page I of 3 Emergency Response Phone Manifest TrackingNumber 4. M(('' WASTE MANIFEST CA� 1 1-8878&72 U L Cr 5 10' S FLE 5 Generators Name and Mailing Address Generator's Site Address (if different than mailing address) TraeatLCLo Uc BA Stockton Lo&d a LLC StoCMIlli, CA 95206 Generator's Phone. b. I ransporter 1 Company Name U.S. EPA ID Number Adw"d Ctxx i l TWAPOrt W. (SV) rAR00007n o 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number AdYWWod C hemicei Troatrrreot NK0002201011W 6133 Edith MW NE AI 9WVq^ NAA 67107 Facility's Phone: 54543494WO ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No Type HM and Packing Group fif any)) Quantity WtNot . 1 Non-RCRA Havai&um WaneSold (Oily Saldal) p 3612 O W Z 2 W I I 3. ) 4 14 Special Handling Instructions and Additional Information ` •.qa..• ftw6w QW4 {1pt umili ti 07A71 1)EREW, A(:TEIM TRIM 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, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If exportshipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. enerat errs Pnnted ype Name Signature nth ay ear X �!N .�Izf• I— 16. Intemational Shipmentst- LlImport to U.S. ❑ Export from U.S Port of entrylexit: Transporter signature for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintediTyped Name Signature Month Day year M Q Transporter 2 PnntedrTyped Name Signature Month ay ear f- 18 Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Re�eclion Manifest Reference Number: 18b Altemate Facility (or Generator) U.S. EPA ID Number SEP 0 8 1P15 a " LU Facility's Phone: 18c. Signature of Alternate Facility (or Generator) - ,Month ._Day„ ,Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) .LJ 1 2. 3. 4 20 Designated Facility Owner or Operato : Certification of re f hazardous materials covered by the manifest except as notedjn Item 18a Month Day Year PnntedlTyped Name � � / Signature i" l� ..' rAru ITV Tn rIPWIPRATf1R ENA Form biuu-[L (Nev. 5-uo) r-reVIOUS eUmuns me U-1crc.