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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />Form Approved. OMB No. 2050-0039 <br />`tPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(continuation sheet) <br />121. Gene Number <br />C A„ 5 7 2 0 9 0 5 1 9 <br />22. Page <br />2 <br />23. st Tracking Number <br />007735789 JJK <br />^4. Generator's Name <br />Stoc]:tan CS1"'1 <br />8020 South Airport Way <br />Stockton CA 95206--399 <br />25. Transporter Company Name U.S. EPA ID Number <br />O.C. Vacuum, inc. CAT 0 8 0 0 3 2 5 3 <br />26. Transporter Company Name U.S. EPA ID Number <br />27a, <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />Wtivol. <br />31. Waste Codes <br />No. <br />Type <br />RQ 6as�_e, Flammable sol.i.d, oigani.c, n.o.s.L: <br />(IJiescal.), 2.:1, lrPl13:' Pr�III <br />r <br />n <br />t <br />11 <br />Z1()t.) <br />ac <br />0 <br />W <br />Z <br />W <br />32. Special Handling Instructions and Additional Information <br />S) ii5 at.,-r'I:..nr ...'1- +1- •'). PF.r'� ,- .-(1 P:p.G# 1..: <br />33. Transporter Acknowledgment of Receipt of Materials <br />H <br />d <br />Printed/Typed Name SignatureMonth Day Year <br />�C Gl w� / .et Qr' l' �J �' ��J .-tom �J I 'r _ . L ,'� <br />y <br />Z <br />34. Transporter Acknowledgment of Receipt of Materials <br />rr <br />Printed/Typed Name Signature Month Day Year <br />35. Discrepancy <br />J_ <br />V <br />Q <br />V._ <br />Hazarclorl s e Rep rt Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />r <br />W <br />0 <br />`tPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />