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vow <br /> Generators Name andArli Mailing AdAW/Panss Ge <br /> dre �era�r d n r E g pass) <br /> Air'di <br /> 48:55 5 Highway 99 <br /> Stelcktin • CR 95r'2fi 8 54 <br /> GeneramrsPnana: 209-948-kxf?,f: 6 2015 <br /> 6.Tranrrfer1 ny Neme U.S.EPA ID Number <br /> 7;AF).-TY- T' cYt,TSms' Tw. L 7XR@Q��RiBlvOa <br /> 7.Transporter 2 Company Name UC Op TU nCDODTtAp!'A1lEPA ID Number <br /> 8.Designated Facility Name and Site Address Urf* HAPN(tR'a ARAGONITE I., U.S.EPA ID Number <br /> I 16 NORTH APTUS ROAD <br /> 4= fi84-814r4? U I)981`,: a117 <br /> FacililYs Phare: <br /> ga, 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Centel ners11.Total 12.Unit <br /> HM and Padding Group(if any)) No. Type Quantity WtN01. 13.Waste Codes <br /> y 1' ON317', WASIF 601.TW3 f-mr—AINING M lwl P,038 13 <br /> o ! L.ANMALk 1-I0UTT y N, +, , (U r. 7L-I:NE, <br /> )WNZE NF), 4. 1, PG 1 ! % Jr <br /> z 2. <br /> w <br /> t7 <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information ., <br /> 11��1� dr}- t,t::;y4,i^• Hid18865 <br /> L-111-Y #1-800-4r.;: VY-KI-FEW <br /> >n1� <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 classifieQpa5ged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition far transport according to applicable international and national governmental regulations.If export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknoxledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)('d I am a large quantity generator)or(b)(if I am a small quantity generator)is We. <br /> GeneratoesrOffames Printedrryped Name Signature Monti Day Year <br /> J 6.International Shipments <br /> f— ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TramporterAcknawledgment of Receipt of Materials <br /> Sj Transporter 1 Printedrryped Name SgnaNre - Month Day Year <br /> O <br /> It <br /> G Transporter 2 PnntedfTypedName' ' signature s Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Mantest Reference Number, <br /> F 18b.Atemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facilitys Phone: <br /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> r <br /> z <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> 1 Printed/typed Name Sigiature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL C'.'",' <br /> r � <br /> 0 0 <br />