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i <br /> Please print or type.(Form designed for use on elite(12-pitch pewritec) orm Approved.OMB No.2050-0039 <br /> fFWASTE <br /> ORM HAZARDOUS. 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number /� (� p MANIFEST T CA0001826S 4 BW74$-7'44$ O 0 7�� �ry`# G D F <br /> 3qfta N e ddress Generator's Site Address if different than mailing address <br /> 79108 LONGE ST. <br /> STOCKTON,CA 952M <br /> Generator's Phone: . '209- <br /> 6.Transporter 1 Company Name U.S.Ei Number <br /> SHOP MW06 SOLUTIONS,INC.. CAWDO 7r <br /> 7.Transporter 2 Company Name GEM has the appropriate U.S.EPA ID Number <br /> a.De¢i a d d LLC- peFmits , and will aGiiU.S.EPA 10 Number <br /> 11855 W TE=ROCK RR. the waste this generator is CADMI304183 <br /> RANCHO CORDOVA.CA 85742 <br /> Facitity's Phone: <br /> 161-10M shipping <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group('rf any)) No. Type Quantity Wt.Not. <br /> 1. 61I S,N. . ,UN1993,0(witcbr} paint) i G DWI FOW 214 <br /> p cl o1,II <br /> W 2. HK411i W05�,Sohd,N 0.6.,9,011 r 7:01(tahromici{ 007) 4#55 P D007 431 <br /> CD <br /> s <br /> 4. <br /> FILTER BAGS,ERG.#128 <br /> PROFILE#142791.0,DRIED P)406A ATE SLIJIDGE W CHROMUM ERG 0171 <br /> ATE Pf ECTM CL07HW <br /> 15. GENERATOR'SIOIFFEROR'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 govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment oonform to the terms of the attached EPAAcknowledgmeni of Consent. <br /> I cartify that the waste minimization statement identified in 40 CFR 262.27(a)('d I am a large quantity generator)or b)(K I am a small quantity generatorJ.is true. <br /> Geherators/Off�s PZntedFTyped Name Signature Month `Day Year <br /> 16.International Shipments ❑ �1 C j <br /> Import to U.S. iJ Export from U:S. ' Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S,: <br /> 17.TransporterAcknowledgment of Receipt of Materials <br /> LLJ <br /> E2T r 1 Print dFrypetime Sig t Mo th D Ye <br /> O <br /> aL <br /> CIM allL <br /> U) <br /> zZ r 'sporter 2 Printedtryped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej j <br /> ❑Partial Re colicin ❑Full Rejection <br /> Manifest Reference Number: <br /> F 18h.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Facility's Phone: <br /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hai Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. � I <br /> 1 I q 1 1 <br /> 3. 4. <br /> 20.Desi n3ted Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in m 48e'" <br /> Printeditype °Name Signature Man Day ar <br /> EPA Form 8700-22(Rev.3-05) Pre us editions are obsolete. <br /> ?` ✓ DESIGNATED FACILITY TO GENEF�ATOR <br />