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&7 . CC MAN ST B( C/AM ?6 .Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 r? UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Resp se Phone dl 4 anifest Tracking Number p WASTE MANIFEST ,,a#4(�ty:;�tl�i,ts".t -# 0W746 ;1W 5 G D F 5.Generator's Name and Mailing Address Generator's Site Address(if diffusigAw mailing address) tt1 1 fpw ,t14C ..._s MANTECA,(.,A M317 Generator's Phone:10a i '3 t;Pi 1 6.Transporter 1 Company Name U.S.EPA ID Number 4-KA, US W.J.rTIV-44S,INC, �:�aF�1t►19 t ttt� 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number #irvdt*On. RAW,W COFOMA,CA V5142 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. f�Q1 r;r,r:PA114 I 141.,J^ LV K41 VJt >.3.( �%J,0 mi) t 4 �' IG W01 FVA3 3,31. O w UJ CD ILZ 3. 4. 14.Special Handling Instructions and Additional Information }, Fc1s.€= it3t� ..ftf. ! T itfir #r ` +W,xi•'F AXE-f440TEC1'fV C10 TRW SE-E.F'P(7,4170 0 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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 true. Generator's/Offeror's Printed/Typed Name Signature a Month Day Year " S - 4 a cauav�,y... C. t ri 16,International Shipmen s F— Import to U.S. Export from U.S. "Fort of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials i Transporter 1 Printedlfyped Name Signature Month Day Year O a QTransporter 2 Pn yped Name Signa ure Month Day ear H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W18c.Signature ofAltemate Facility(or Generator) Month Day Year Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Notice:New federal form. State of 2. 3. California requires generator to photocopy and mail to DTSC within 30 days: 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18i P.O.Box 400,Sacramento,CA 95812-0400 Printed/Typed Name Signature EPA Form 8700-22(Rev.3-05) Previous editions are obsolete.