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03-04-'15 15:52 FROM- les Environmental 661-322-8883 T-454 P0009/0012 F-956 <br /> Please print or type.(Form desinned for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Gagpralor ID Number 2.Pagetof 3.Emergency Response Phone A.ManifestTraOxing Number <br /> WASTE MANIFEST r:ALLOOD358M 1 209-460-0480 01 4 3 5267 JJ K <br /> 5.Geeemtors Name and Mailing Address Generators SileAddress(9di0erent Nan malling address) <br /> PACIFIC SOUTHWEST IRRIGATION <br /> 8372 S.JACKTC)N RD. <br /> STOCKTON,CA 55215 <br /> Geheratofs Phone: 209.460.0450 <br /> e.Transporter 1 Company Name U.S.EPA ID Numbor <br /> George W.LaeYry,ire_ CAROM7019 <br /> I.Transporter Company Name APR 08 2015 U.S.EPA ID Number <br /> 8.Desi rated F Name end Sit d roes U.$.EPAID Number <br /> �0W171hStreet lldC. ENVIRONMENTAL <br /> 1610 W 17th Street - C„�<�:,.,,.r� <br /> LONG BEACH,CA 90813 HEALTH OFPARTAACRIT <br /> Fad6ye Phone: BDD-827-6729 <br /> ea, gb.,U.S.DOT Description Including Pieper Shipping Name,Hazard Class,ID Number, 10.Conlsihefs 11.10m1 12 Unit <br /> HM and Paddng Group(if any)) No. Type quangly W0101113.Waste Lades <br /> w X 1. UN 1133 WASTE FLAMMABLE LIQUID O. D. G. <br /> (DWI) (A4heGMe'o) 3. PG11 I OM �0 G Dowloh <br /> 2 ✓� � <br /> co <br /> 3. <br /> 4. <br /> 4.Special Handling lnebucaons andAddiftal Information <br /> ERM2B Telfahydrotmn ar Methyl Ethyl Ketone PVC pipe glue <br /> USE CLOVES PROFILkTi 9657, INVOICE# �U7j'7 <br /> 16. GENERATOR'SIOFFEROR'S CERTIFICATION:Iherebydedare Nat the contents oflhfswnsigmnentatefulyandacyurelelydcsoYbed above by the pmparshipping name,ardemdessiffed,paelaged, <br /> marked and Izbelealplacardad,and erain all respectsinpmpsrmnddonfortmnspottecoording to appumble Infemadonaland national governmentalregulators.llexportbIpmantand in IhePdmary <br /> Exporter,I cerdyIhafthe foments ofdCs conslgnmantconformlo the terms of the attached EPAAcknowledgmentof0cmas G <br /> 1 eer0y that thewasle minirnbcallon statement Identified fn 40 CFR 262.27(a)(dl am a lame quantibgenemlod or(b)(Ifl am nsmall quanalygmemlor)is W e. <br /> Gmemtofslofferofa PrinledfTyped Name Signature Ma�rroT ❑ Year <br /> Gi 57,e mf en aw <br /> F 16.Inlemagonal 3hlpmens ❑import to U.S. ❑ <br /> Export from U.S. Pon of enivepC <br /> 2 Trebspoderaignelure(forexp0rteronty): Dai leaving U.S.: <br /> 17.T1anspoderAd mvledgmehtofReceplofMeledals <br /> Trmspmlert city ypedN signature Monro Day Year <br /> 65 <br /> C Tmwponer2P ed Name Slgnstua Monro Day Year <br /> a <br /> .}. 18.Discrepancy ' <br /> 1aa.Discrepancy lndw6ori Spam ❑ Quarry ❑Typ¢ <br /> El Residua ❑Penial Rejeaion ❑Full Rejection <br /> Mangsel Reference Number. <br /> 18b.Alfemale Far❑ry(orGanemmr) U.S.EPA ID Number <br /> U <br /> Faciglys Phone:' <br /> lee.Signature ofAllemale Facility(or Generator) Month Day Year <br /> K <br /> i "Ded2wlBdFaaTj� <br /> Managemen(McOwdCodes(a.,odesfor hazardous waste treahnent,dispwal,and Meydingsystems) <br /> l2. 3, 4. <br /> r Opeatior.Cethambon afremiplofhazatdousmafeda&covered by the ma a pl asndedin Ilam Jae <br /> �igtture Montydy Y <br /> EPA Form 8700-22(Rev.3.05) Previous editions am obsolete. GNATEDFACILITY TODEST ATIONSTATE(IFREQUIRED' <br />