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Please pnnt Of type.(Form designed for use on little(12-pitch)rypawnter.) <br /> 1.Gweremr ID Number FormApproved.OMB No.2050 003 <br /> UNIFORM HAZARDOUS 2.Pega1M 3.Emergency Response Phone 4,Manl(est TracMngn <br /> WASTE MANIFEST CAL008 IW4 1 ,ABB-785.722s p p g g 2 4 3 FLE <br /> SGerlereloYSNameaarA MaYilq AddaSa <br /> Sign <br /> GeneraloYs Ile Adaess(i tlIHBRRI than malting adtlnfss) <br /> 101 111"tfldD"Stockton, 6A gm <br /> h <br /> Genemoes Phone -7151 <br /> renewer any ams <br /> Ad�enced�i11B1111C8�'rjemport)m (gy) U.S.PAID Number.R000070545 <br /> 7.Tranmonar2 Company Name <br /> US.EPA ID Number <br /> S, esgnaredF (y Nam <br /> am$il¢Ad" <br /> Address <br /> 8133 MUM INGEW Thi U.S.EPA D Number <br /> Albuq ,.yy,N�M��87107 <br /> Fadliys Ph .IWW <br /> aa, fir.U.S.DOT Dff:dplbn(mdWmg ProM SFippirg Name,Hmand Class,ID Number, 10.Containers <br /> RM and Parking G"N arty)) D TOIY 12Um1 13,Waste Codes <br /> ad <br /> No. Type uanHty WINoI. <br /> w <br /> ams <br /> u X 3 DM P <br /> 3 <br /> 4. <br /> 14.SpetlalHaidlil'S INLlpholedAMHhawllnfwma <br /> 1) ACp8M8864Mjllon_WA- 1T <br /> 2)EROk12B, AGT�8447SLM�7.� � <br /> 15. GENERATOR'S'OFFEgOR'$CER11fICATION:conteIherebydedare that the.""m oflhl Wegnmentarefu9yandaavalstydeswbad above by thepaper shipping name,and are daazfied,packegeq <br /> ExporI Iseldy <br /> marked are taboosNplamNed and are in all mspecss m proper mndban lar Eanspwn modedbM to epphooEm intemationel and rational gaanrmenblr ulallaH.lf ez pm <br /> ter, that ate nts l ibis pconsignment ocvffam to the brrte Mme aHxhetl EPAAdnavledgmenl of Consent <br /> ergYS . Port ahl enrand l am be Pnnery <br /> cedHy that the wastemulini¢aa'on sblenent m idred m 40 CFR217(a)(H I am a large quantity g <br /> 26enerator)a(b)(I I amasma!I quantity genarabr)b nm <br /> e S Pmi yp <br /> F 76.In@melienal Shipmenb� � � � �J 1� <br /> a ❑Impan.o Us. ❑Ex,on from .S. Port of eNryfee, <br /> Trans «lir s' us fora orison. : Data leaving U.S: <br /> TranspaterAcknvMedgmlint of Receipt of Ma5 <br /> ran ponerl nle N`me 1 <br /> O a u on (/y��y)��; et <br /> CTana der2 PnNedRype !lame nature "' r <br /> mear <br /> } 16.Discrepancy <br /> 18e.Ducrapancy lnd.mn Space ❑ Quantity ❑T <br /> vPo ❑Residue ❑ParYel Rejection ❑FW Rejecdor <br /> 166.AR male Facility for C....le, MenHem Reference Nember. <br /> ., U.S.EPA ID Num.bar <br /> V <br /> Q <br /> p- Fficilll'S Plwre: <br /> ZIAC,Signature V.A5ernata FeMt,I,,Generale) <br /> Month Day Year <br /> W <br /> 65 19.HazaNnus Wasle Repo d hW <br /> nagemanl Method Cocos(i e,.mtles for hazardous waste treatment,disposal,and reryding systems) <br /> ❑ t 2. 3. 4. <br /> 20.Desighelstl Facility Omer or Ope2loc Cemhcallon of receipt of haeamws materials evened by the manifest".sept as note]i i Irem 1Ba <br /> I <br /> P�inled yped Nama Sipnslure <br /> Alonlh ey Year <br /> EFA Form 6700-22(Rev,3-05) Pmvlous editions ere obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF RF.OV168i1)) <br />