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RECEIV,- MAY 2 9 2007 <br /> int or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> 1. enerat r ID Number 2.Page 1 of 3.Emergency�ty�porx� PJhoQ�} ,'rr 4.Manifest <br /> Tracking Number <br /> JWASTE MANIFESTNIFORM <br /> �a ��s�a) I-I�� 000555230 FLE <br /> Ieneralor's Name and Mailing Address l ; �j �S,2C� I Ggneralor's Site Address(if different than mailing address) <br /> 1 ) c��1�� <br /> W, �ose i'rit <br /> Generator'sPh1o�nn lgQ��{��n 301-J { z 1 )f"] c �> � \ ( <br /> 6.Tra�itiC 06X YTfF,t...i-EY f STE Oft. U.S.EPA1{� <br /> 7.Transporter <br /> F2CCompany Name U.S.EPA I'D Number <br /> 8, I U.S.EPA ID Number <br /> 535 CLAUS ROAD t..AE.I!bIt03.50Sa-45 <br /> RIVERBANK,CA 9M 209-863AM 81 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. -Rf,;KA HA4F.AK1XXJ5l + w 21 <br /> 0 ( SED QTLY W AM--R 7 r; iP -f T <br /> Z 2- <br /> w <br /> c� <br /> 3. <br /> 4. <br /> Special Handling Instructions and Additional Information <br /> GLOVES <br /> 15. GEN ERATOR'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 classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)('rf I am a large quantity generator)or(b)(if Lam a small quantigenerator)is true. <br /> Generator's/Offerors PdntedlTypedNiame Signature �r j on ay ear <br /> �rSh <br /> -j 16.International Shipments ! I/ <br /> H ❑Import to U.S. ❑Export from 11 S.0 Port of entry/exit: <br /> Transporter si nature.for exports only): <br /> Date leaving U.S.: <br /> w17:Transporter Acknowledgment of Receipt of Materials. <br /> Transporter 1 Pnntedlryped Name Signature Month Day Year <br /> IF <br /> Z iz <br /> Z Transporter 2 Printed/Typed Name - Signature Month Day Year . <br /> Q <br /> r— <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Altemate'Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> a <br /> LL <br /> Facility's Phone: <br /> W18c:'Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z. <br /> c7 19.Hazardou <br /> U s.Waste Report Management'Method Codes(i.e:,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 4 r /( 2. 3. 4. <br /> 20.Designaled.FacilityOwner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnnted(fyped Name Signature -! Month Day Year <br /> 1.EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />