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LP 9 5 • <br />Please pint or Noe. fFbrm desladed for use an elite (12-oilch) typewriter.) <br />DIP C C. ^ R S 0.,I scci f5 0 1 <br />Farm Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (RK. -3.05) Previous ekfjfions are obsolete. DESIGNATED F�C{ Td DESTINATION STATE= (IF REQUIRED) <br />10320.0680 �� <br />UNIFORM HAZARDOUS 1. Generator 10 Number <br />2. Page 1 of <br />3. EmergencyAaspansa Phone <br />0. Manifest Tracking Number <br />1 003884894 JJ K <br />WASTE MANIFEST CALOW1SU71 <br />1 <br />8 321-1030 <br />S. Generators Name and Maling Address Generators Site Address (d diflerenl Nen mulling address) <br />Central valley Waste Service <br />133 East Turner Road <br />Lodi, CA 95240 <br />Generators Phone: 20}7.69-8274 <br />6. Tr It 1 Com any Name 1 <br />U.S. EP 10 Number <br />7. Transporter 2 Company a <br />U.S. EPA ID Number <br />S. 0-mmaI uff M3fidA <br />U.S. EPAID Number <br />Pnefa <br />CATfA70646117 <br />.35251 Old Sityllne Road" <br />ICehlernan City, CA 93239 <br />Farr sPhoner 65-9711 <br />go. <br />9b.U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. C011411nerl <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Parking Group (if any)) <br />Quantity <br />MjVot <br />m <br />1. Non-RCRA Hazardous Waste, Solid (son with lead) <br />1 <br />DT <br />18 <br />Y <br />611 <br />0 <br />Z <br />2, <br />w <br />c9 <br />3. <br />4. <br />anal Handling Instructions and Addiliona motion <br />Wear Proper Clothing When Han g Material. <br />ERG # N/A <br />Pro111e # 9866 <br />CA22 (soli cAv lead) <br />75. GENERATOR'SIOFFEROR'S CERTIFICATIO I hereby declare that the contents of this consignment artfully and accurately described above by the proper shipping name, and are patented, packaged, <br />marked and I beleNplamroedandaramall spects in proper condition for transport according to applicable international and national governmental <br />regulations. If export shipment add l am the Primary <br />Exporter, I ceMy Nal Ne contents of this signment conform to the lertns of the attached EPAAcknowledgment of Consent <br />I certify that the waste minimization ement idenfified in 40 CFR 262.27(a) (A I am a large quantity generator) or (b) (if r am a small quantity generator) is We. <br />G eators/Ofie rs PdnteNTyp arae Signatore <br />Month Day Year <br />qJ <br />1 <br />.X.l <br />F <br />16. International Shipments <br />❑ Import to U.S. ❑ &Nd horn U.S. Pad of entrylexit <br />Z <br />Transporter signature (for exports only): Dabi leaving U.S.: <br />w <br />17. Tran der pu dgmenl of Receipt of Materials <br />ad <br />Tmnspo r 1 n toMyped Name Signalwe <br />Month Day Year <br />O <br />Wi <br />crya14- <br />Transporter 2 Pmrod7Typrd Name I Signature <br />Month Day Year <br />C <br />r <br />18. Discrepancy <br />18a. Discrepancy Indication Spam ❑ Quantity ❑ Type ❑ Residue <br />❑ Partal Rejection <br />❑ Full Rejection <br />Manifest Reference Number <br />181a. Automate Facility (or Generator) <br />U.S. EPA ID Number <br />J <br />U <br />LL <br />Faalitys Phone: <br />W <br />18c. Signature of Alternate Facility lot Generator) <br />Month Day Vear <br />C <br />2 <br />(7 <br />N <br />19. Hazardous Waste Re rl Management Method Codes (Le., codes for hazardous waste treaanenl, disposal, and recyding systems) <br />� <br />I. --Z <br />2. 3. <br />4. <br />20. Designated Facility Omer or Operatorr.Ce`N—fimtbn of receipt arows materials chased by the manifest except as noted in Item lS <br />Printeortypeo Na Signature <br />/^^ <br />q <br />on <br />+II <br />C.�(/--I�. <br />EPA Form 8700-22 (RK. -3.05) Previous ekfjfions are obsolete. DESIGNATED F�C{ Td DESTINATION STATE= (IF REQUIRED) <br />10320.0680 �� <br />