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<br />Please pent or type. (Form designed for use on elite (12 -pitch) h._�•vriter.) i V
<br />Form ADDroved. OMB No. 2050-0039
<br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. C� DESIGNATED FACILITY TO GENERATOR
<br />UNIFORM HAZARDOUS
<br />1. Generator ID Number
<br />2. Page 1 of
<br />3. Emergency Response Phone
<br />14. Manifest Tracking Number
<br />007735799 JJK
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<br />WASTE MANIFEST
<br />- A h 5/ 2 8 9 0 5 1 9
<br />2
<br />(562) 984-FJ178
<br />Generator's Name and Mailing Address Generator's Site Address (if different than mailing address)
<br />Stockton CSMS
<br />8020 South Airport. Way
<br />CA 95206-3994
<br />Stor,.}c0` '9
<br />Generator's Phone: c 8 5 4 2 1
<br />6. Transporter 1 Company Name U.S. EPA ID Number
<br />O.C. Vac-ulurt Int-- . C, A i i 0- r
<br />7. Transporter 2 Company Name U.S. EPA ID Number
<br />8. Designated Facility Name and Site Address U.S. EPA ID Number
<br />Rha -Chem, ��I.0 (i•SC! C A D r (' R, 3 E 4 4 3
<br />425 ISIS AVE.
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<br />Facility's Pone:LEWOOD CA 50301--
<br />, ,
<br />9a.
<br />9b. U.S. DOT Description (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 />Quantity
<br />Wt.Nol.
<br />' tam ?,erc,-,3o.t-,3, 2.1, uIn195o (D 'r-sr,12842
<br />( �
<br />2' Ww5te, Methyl ethyl ketone, 3, U1411.93, PGII
<br />p
<br />21
<br />1 (
<br />i
<br />D0
<br />Wa.si.e, F']aromable, solids, organic, >,. - .:
<br />343
<br />-
<br />(;;l.inar.al. spirits) 4.1, U;•[;.325, PGIII
<br />�
<br />r
<br />4.wa.ste F.Ii-m cable, solids, +_)rgani.c, n.o.s•
<br />343
<br />(tninetal spirits) 4.1, UN1325, PGIII
<br />pjyl
<br />1,
<br />i
<br />i10+1?:
<br />ti. Special Handling Instructions and Additional Information
<br />i t ,;. -.i_c PRF1 300434-48 ER, -D 12E
<br />_ ,. ase ne BILL ` 0: iu_' vA.CLA.Ii4
<br />1:31Cii: 'I", ; lrlil�:1' pp.r* ,ff� F. R0% 12.7
<br />.. L:31rlt 'j -:brie Ell 14D Wr)s.K st6,r--l:: 44461
<br />,. G.'1T17 P'.`J P"ilI}i' :19T. r' r.'F'P z1 ii�:)v'.3-�1'i' Rr.G1 13; pi,(F ;I"• :f �LSti-11. --[}-I t11. r'•a_t}, .. '
<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 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 EPA Acknowledgment of Consent.
<br />`d
<br />I ceJ41hat the waste minimization stale nt ideotifi in 40 CFR 262.27(a) (if I am a large quantity generator) pr(b (if I am a small quanti 4anerafor) is truq:�''
<br />Gene ato sly(/��Q�gr�r&Prin
<br />yppd NaeV
<br />/Signatur "� / j Month Day Year
<br />WJ
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<br />16. Infemational Shipments
<br />❑ Import to U.S. ❑ Export from U.S. Port of entrylexit:
<br />z
<br />Transporter signature (for exports only): Date leaving U.S.:
<br />LU
<br />17. Transporter Acknowledgment of Receipt of Materials
<br />Transporter 1 PrintedlTypgd Namet r Signatu!e �, s Month Day Year
<br />ok
<br />ZZ
<br />Transporter 2 PrintedlTyped Name Signature Month • ay Year
<br />F
<br />18. Discrepancy
<br />18a. Discrepancy Indication Space ❑ Quantity ❑ Typej j
<br />❑ Residue El Partial Rejection Full Rejection
<br />Manifest Reference Number:
<br />18b. Alternate Facility (or Generator) U.S. EPA ID Number
<br />J_
<br />CJ
<br />LL.
<br />Facility's Phone:
<br />W
<br />18c. Signature of Alternate Facility (or Generator)
<br />Month Day Year
<br />Q
<br />Z
<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />2. H OW
<br />3.
<br />��
<br />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 />I
<br />Ftted/Typed Na e,�, t - Signature
<br />J M
<br />nt Day Year
<br />jl
<br />U II .SAT � ���
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<br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. C� DESIGNATED FACILITY TO GENERATOR
<br />
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