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,/ f Z'C - 1 Z3 - <br />Please print or type. (Form designed for use on elite (12 -pian) typewriter.) <br />.I Z,4 <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. - I DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS <br />1�Gengra16 umjer 2 5 g „� ' <br />AA fUJ t$3 <br />2. Page 1 of <br />1 <br />erp�gC e¢ponse Phone <br />OOzzss�S +���v�i <br />4. Manifest Track' Number <br />9 60145 JJ K <br />WASTE MANIFEST <br />5. grflWeWUMailing Address(�(i si�d) (if different than mailing address) <br />Ate: Fat GUNemtety, 5200 Sheila Street 1990 PICCaN Rd. <br />C nifne e CA 90040 Stockton CA 95215 <br />323 254-5200 <br />Generator's Phone: <br />s. Va't�MKsaTAc. - us. A N�,b 0 0 1 2 8 0 0 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />a. �§~Ybdwn Address U.S. EPA ID Number <br />5375 South Boyle Ave. <br />Vernon CA 90058.;: <br />8M_2W-7747 CAD097030993 <br />Facility's Phone: <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />' <br />o <br />(o1ft o tent) <br />DM <br />/ <br />P <br />Z <br />WRECL.1 <br />2. <br />L.0 <br />I <br />3. <br />JUL-2 III <br />4. <br />ENVIF <br />ONIV <br />ENT L HEALTH <br />DEP <br />14. Special Handling Instructions and Additional Information <br />3 <br />9b.1) oil/absorbent pro,file#AF165407E � <br />' <br />Gloves & Goggles <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 EPA Acknowledgment of Consent. <br />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. <br />Gen er fferor Printed/Typed Name + Signature �; ` Month Day Year <br />G <br />Af�/</ ,� r ._--, <br />J <br />j.-. <br />16. Intemational Shipments <br />❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />�r <br />17. Transporter Acknowledgment of Receipt of MaterialsLLJ <br />Transporter 1 Pn I dnyped Name Signatu Month Day Year <br />n <br />N <br />�� t° l ca <br />ZZ <br />Transporter 2 Phnted/Typed Name Signat a Month Day Year <br />tY <br />t- <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ 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 />LL <br />Facility's Phone: <br />W <br />18c. Signature of Altemate Facility (or Generator) <br />Month Day Year <br />Q <br />Z <br />N19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />W1, <br />2. r•.'t 3. <br />4. <br />20. Designated Facility Owner or Operator: Certification of r ceipt of ha$bh)ous materials covered by the manifest ex pt as noted in Item 18a <br />Pri a Sig nat re Monte Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. - I DESIGNATED FACILITY TO GENERATOR <br />