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';W Pk�.ase nrint nr tvne_ (Form designed for use on elite (12 -Ditch) tvoewriter.) Form Approved. OMB No. 2050-0039 ! UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 1 00773585to JJK WASTE MANIFEST r• (-> c, -; 2 i O 0c, G I (ci1?) QRB--F;,7a • enerator s Name and Mailing Address Generator's Site Address (if different than mailing address) Stockton CSP4 8020 South Ai rpc rt Way Generator's Phone: Stu " c) _ C7, 95206--399 6. Transporter 1 Company Name U.S. EPA ID Number W.- T -n 7. Transporter 2 Company Name U.S..EPAID Number -' - 8. Designated Facility Name and Site Address U.S. EPA ID Number CROSBY & OVERTCPI C A F, 0 7 8 4 0 9 0 1 9 1610 W. 17TII ST. Facility'sPWn'E4'= PEA(71 r',+, ( i ?. - ga 9b. U.S. DOT Description (including'ProPef Shipping ame, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol, 1. Or ) , l ` z 2. LLJ idon-f'CR?i H zardou tta:�te, so1:L.i ( C?a_�5) 357 0 3 c -, Flcn-I:'CF:r`, lI:ozard: its= ,.ast-, �•,1 i<l I: a;f) - F' _33 _-- k V 4. i i Special Handling Instructions and Additional Information L d.-: ..' VAC IJUM r - i311 ,% C'y//{ n/a F� ;r# n' n 14" T �� !'? ti 4 (1(a. p ,!1 ,r, I 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, 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. ; I certify thal.lhe 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. Genera fferor's Printedrryped Name / �' Signature `• / 77 Month Day Year F— 16. International Shipments--- ❑Import to U.S. ❑ Export from U.S. 1 Port of entry/exit: Z Transporter signature (for exports only): Date leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedrTyped Name - Signature Month Day Year O CL 71 zQ Transporter 2 Printedrryped Name Signature Month Day Year H 18. Discrepancy 18a. Discrepancy Indication Space Quantity D Type El Residue ❑Partial Rejection ❑Full Rejection CED WASTE WAS RECEIVED, HANDLED AND SPORED FOR SUBSEArence Number: 18b. Alternate Facilitys(toGtberfWTMEN7U.S. EPA ID Number TO THEM. BY THE DEPARTMENT OF TOXIC SUBSTANCE CONTROL. TOW1121 J (7 V}LV.rrS GRANTED ; rlTi TitE ENV[RONMENTAL PROTECTION AGENCY IN ACCORDANCE WITH THE PROVISIONS OF CONSERVATION AND RECOVERY ACT OF 1976 TOGETHER WRH APPLICABLE Phone: 8' RESOURCE TH Facility's S CROSBY A OVERTON HAS ALL OF THE NECESSARY W 18c. Signature of Alti ya " Efpgggra REFERENCED WASTE AND Month Day Year Q k(-CORDINGLY Z rM Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 2. 3. 4. Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Tsignated P!w,t�ed:/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. ✓ , DESIGNATED FACILITY TO GENERATO'