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0 <br />Please print or type (Form designed for use on elite It 2 -pitch) typewriter.) <br />0 <br />nTSC. QC1, 3R. 1D i <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700- (Rev. 3-05) Previous editions are obsolete. <br />10407.1727 <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS <br />I. Generator ID Number <br />2. Page 1 of 3. Emergency Response Phone <br />4. Manifest Tracking Number <br />1 001179418FLE <br />WASTE MANIFEST <br />CAL000194471. <br />1 - 866-333-9222 <br />5. Generators Name and Mailing Address Generators Sile Address (it diderent than mailing address) <br />Central.9alley Haste. 1333 B. Turner &d. <br />VO Box,241001: Lodi, Ca. 95241 <br />Lodi,: Ca.- 95241 - <br />Generatoes Phone: 209 33375611+ <br />6. ransporterl Company Name U.S.EPAONumber / <br />Advanced chemieai,Teaesapert;.,. cAR000010340 <br />7. Transporter 2 Company Name,1 U.S. EPA ID Number <br />l�-,wmwbari 3 <br />S. Designated Faafry Name and Site Address U.S. EPA IO Number <br />•. <br />Clean Barbera - of San..Joill Li (San Jose, racility),,. <br />- <br />1021''Berryessa Bead, <br />San _kToee,'rCA',95133 - <br />Fadiitys-Ptione:408-441-0962' - CAD059494310... <br />93. <br />9b. U.S. DOT Oesmipbon (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 />Dumbly <br />WUvol. <br />1.Viii Paint,: 3,,_,081263, BUZS, <br />.� <br />001 <br />035 <br />343 , <br />8 <br />Q 5 O <br />,, <br />U 0 I <br />DM <br />3 <br />z <br />2. <br />w <br />c� <br />3. <br />4. <br />14- Spedal Handling Instruaions and Additional Information <br />1) ERG.,/:,,128; CH322832.;CSC-801.5594) <br />Project 8rmber t - 18944 . <br />15. GENERATOR'SIOFFEROR'SCEKnFICATION:I hereby dedam Nal the contents of this consignment are fully and accurately desdi above by the proper shipping name, and are dassified, packaged, <br />marked and lamledlplacarded, and are in all respects in proper condition for Uansporl aaurting to applicable intemalional and national govemmental regulations. If export shipment and I am the Primary <br />Exporter, I modify that the contents of this consignment conform to the terms of the avached EPA Acknowleogment 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 we. <br />gra ure on ay Year <br />Generators/Offerors PMteellyped Name16"'a'3&--2 <br />4 <br />1— <br />116 International Shipments <br />❑Import to U.S. ❑Exporthom U.S. UPed ofentymeet <br />z <br />Transporter snature for exports only): Date Imi U.S.: <br />w <br />17. Transporter AcknaMedgmentof Receptof Matenals <br />Transporter 1 Printed/Typed Name Signature on ay ear <br />C. <br />i wr S 6 <br />QimnspPnnledRy <br />ed Name I 1 �gnaNre onth % ay Year <br />18. Disuepancy <br />18a. Dleaepmtey, Irritation Space ❑ Quantity El Type ❑Residue ❑ Partial Reinder, El FJ Rejedian <br />Manifest Reference Number: <br />Ills. Alternate Fader (or Generator) U.S. EPA ID Number <br />J <br />U <br />6 <br />LL <br />Facittys Phone: <br />Mw <br />18c. Signature of Alternate Faulty (or Generator) Month Day Year <br />H <br />z <br />z <br />N <br />19. Hazardous Waste Report Management Method Codes (i.e.. codes for hazardous wash treatment, disposal, and recycling systems) <br />o <br />I. 1 <br />lM. <br />2. <br />20. Designated Fadlity, Omer or Operator. CeNftation of receipt of hazardous materials covered by Ne manifest except as noted in Item 18a <br />Pp.N¢drr ed .e t� �\a� - tura Month Day Y� <br />EPA Form 8700- (Rev. 3-05) Previous editions are obsolete. <br />10407.1727 <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />