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— " Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> QNIFORM HAZARDOUS 1.Generator ID Number .Page 1 of 3.Emergency Response Phone d,Manifest Tracking Number <br /> WASTE MANIFEST /_. �, n 0 u 7 d E n. + n r 'r-;^+^_nrl�-7 000543018 VES <br /> 5.Generators Name and Mailing Address ppI - G4neratdrs Site Address('d different than mailing address) <br /> IPR PPT.AS r''JE a.Af':iE <br /> STOCKTON,CA 98 08 <br /> Generators Phone: 20•- 483-60114 <br /> 6.Transporter l Company Name U.S.EPA ID Number <br /> tr OLiA. Fg TFC k.((•^A L:3;;1 jjTtOMS <br /> 7.Transporter 2 Company New U.S.EPA ID Number <br /> N1PENVIRONMlEP.11-ALSERVICES C .A T O Q :7 8 2 4 2 4 7 <br /> B.Designated Facility Name and SAeAddmss .U.S.EPA ID Number <br /> %I C 0 U A E:-STECHNICAL ,0L.J1—n0 ' <br /> 17PIAIN.FIRar STREE l <br /> FadliysPhone: jje T,4-5:'l7 AZUSA,CA 91702 <br /> ga 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> and Packin Group d an 13.Waste Codes <br /> HM 9 P C Y)) No. Type Quantity WtNol. <br /> RAZAROC)US+-. . T<' 352 I <br /> 0 0 2 C TM 00825 . F _ <br /> A_ZARDOUS N,rq-/r U'01JUD, 0JM B11IGuLY 4911 <br /> w D M 0 'i 50Il ? <br /> 3. <br /> 4. <br /> 14.Spada]Handling Instructions and Additional Infomation Sa _,, - „ E <br /> F,'� ,r!ic?C.QnTracted L�,b/�_cl ; -I- i l 411:1005:'.P.:A�U-DEE3!FUEi_fNS c X_�5GAL 2} <br /> 1r,F 1005a".A:PEC t%A7ERNIIDM.A)3 X F5GAL . <br /> 15. GENERATOWStOFFEROR'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 Iabeledtplacarded,and are in all respects in proper condition for transport according to applicable inlemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,l mrfify that the contents of this consignment conform to the terms of the attached EPAAcknoWedgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I are a large quantity generator)or(b)(If I am a small quantity generator)is two. <br /> Generator's/Offences Printecirtyped Name Signature) j Month Day Year <br /> 1. 11.._:i i��r^^� ., i 1 10 1 It i <br /> J 16.International Shipments / <br /> p_ ❑Import to U.S. ❑Export from U.S. Port of entry/exit <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> IX W 17.Tran-sporterAdmowledgment of Receipt of Materials <br /> Transpoder PnnledRyped Name Signature Month Day Year <br /> a FRED WESEM+IA.N I 1 Ila. 11 ; <br /> QTmnsporter 2 Pdd/typed Name QN N�;r.f }"t,� 447 Signature II )) JJ Month Day Year <br /> FJJIESE�?s ,J MI' E.JVI.,r,/ s�IGS ./t L1/.fov�2tz.-ti/' <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity, ❑Type ❑Residua Ll Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> iall.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ra+. Fadlitys Phone: <br /> w 1Bo.Signature ofAltemate Facility(or Generator) Month Day Year <br /> 4 <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1 2. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the whitest except as noted in Item 1B <br /> Fri, yped Name I 1 G' Hato (/ Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Pieviouseditions amobsolete. DESIGNATED FACILITY TO GENERATbR <br />