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PleaeMr1,,"-.-.1,ype,(Form designed for use'on elite(12-pile�.j 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 CALD981671979 1 L4Ott-1'467443,1 0032359E2 JJK. <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> INTERSTATE TRUCK CENTER 025 NAVY OR- <br /> W.O.11309 15403 S'TOCKTON,CA f152116 <br /> S'I OCKTON.CA 96206 <br /> Generator's Phone: FDLI-33ol-45513 <br /> 6.Transporter�l Company Name U.S.EPA Ib Number <br /> SHOP HALMDS SOk..U11ON1 c:Al�i)�3Cr44+1[�44tf7 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.Ras' ate- aci i Name n i9s_Ad ress U.S.EPA ID Number <br /> M-W 6MAOM LLC:. C:t�C�ABtyt�i3<I;tea <br /> i 18M V41TE F?(XK RLD• <br /> RAW f K)COROCIVA,CA 9574 2 <br /> Facility's Phone: 9i&351-0[W9a 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> t. VdaistoAerosols,f1w mekest,(*$ohriot*Aveddn)gi L0&FrSi;iN 2 , DfA ' , P D001 1 331 <br /> o UNtf ID, tD0013 <br /> Uj <br /> 2. I <br /> 0 SrAVrrfi✓�iii {L... <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> YN 1i 41vtxhlw dot 1621,Mac 1;rttAeruW5,ENG#126 <br /> Hppr #t9 PrOt'ec M161 Cl*" <br /> 15. GENERA7OR1510FFEROR'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 labeladiplacaMed,and are in all respects in proper condition for transport aocording 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 EPAArknowledgment of Consent, <br /> i cartify u al the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(IN am a small quantity generator)is true. <br /> Generators/Offerors PdnteVyped Name Signature r _ Month Day Year <br /> Yo IJ <br /> -j 16.FMMboflbl Shipments ` <br /> Importto U,S. ❑Export from U.S. Port of entrylexiL <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter'l Pd edlfyped Name Sign ure Month Da Year <br /> l, , - - , j 171 <br /> 1 <br /> 0 <br /> Q C. 4 <br /> TranspDrJW2 PAnfMpeffNarhe Si nature Month Day Year <br /> ce <br /> M <br /> 16.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> _ Manifest Reference Number: <br /> 1 Bb.Altemate Facility(or Generator) U.S.EPA ID Number <br /> _J <br /> (.3 <br /> +a+- Facility's Phone: <br /> LLI 18c.Signahxe ofAJlemate FacJity,��Generainr) Month Day Year <br /> a <br /> Z __ _ <br /> 19.Hazardous Waste Report Manars,nent Method Code:(i.e.,oodes for hazardous waste treatment,disposal,and recycling systems) <br /> © 1. r <br /> 3. 4. <br /> ' 't. <br /> 20.Designated Facility Owner or Cy"'nr:L'ertihralian of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdnted(Typed Name Signature . Month Day Year <br /> EPA Folin 8700.22(Rev.3-05) Previous editions are obsole e. TRANSPCJRTER'S COPY <br />