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use 6rjektA <br /> Please print or type.(Form designed (12 ptch)typewriter.) 1, Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS I.Generator ID Number 2.Pagel of, 3.Emergency Response Phone 4.Manifest 77tking Number <br /> WASTE MANIFEST GAL000377552 I (SIX)424-8300 01,1140-51390' J J K <br /> S.,ensM969WIRmy VO LKS,WAG EN Generator's-Site Address(if different than mailing address) <br /> 2266 KMW.WV POAD <br /> UVERMIORE CA -04553. 2606 AUTO PLAZA WXf WWI Ky W10 ON;_ <br /> Generator's Phone: 925 4556-1281 - TRACY CA sold <br /> U.S.EPA 10 Number <br /> CADC28277OZE <br /> Transporter 2 Company Name U.S.EPA ID Number <br /> 8.DesigntFq K.1p1dyN?5e and.,SAe U.S.EPA 10 Number <br /> PLX;A ST R E E? <br /> 0�,A P T ON' CA 90222-2 <br /> Facility's Phone: =01115W-14100 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity V40101. <br /> --71 UNJ6LaWASTE y^ir�'rIMAeLE UOiJUIC.M,0.6-(GA901-117 <br /> UJI <br /> Z 2. <br /> LU <br /> 3. <br /> E -TIVED <br /> (I-,- <br /> 4. <br /> JA 1'1-01F- <br /> 14.Special Handling Instructions and Additional Information <br /> EMUC-6-NCY CON-TACT:CHEMTKC I-GCC-424-5ZW NAERGt SSI 128 PROFILE SE2 37lo-A, GAJ)IMA WJAXG'�4� <br /> 1t,=02:1684S*APPROPRIATE PERSOML PROTEnVE EQUIPMENT <br /> 76 141" <br /> 15.: GENERATOR'SIOFFERORIS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are iclassified,packaged, <br /> marked and labelediplacarded,and are in all respects In proper condition <br /> 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 th s consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minlmization 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. <br /> Generator'slOfferor's Prime, ed Name Signature.6—, Month Day Year <br /> 14 <br /> -j 16.International Shipments .,V <br /> F- 1:1 Import to U.S. IJ Export from L.S. Port of entryled� <br /> 9 Transperter signature(for exports only): Data leaving U.S.: <br /> uW 17.Transporter Acknowledgment of Receipt of Materials <br /> Ji <br /> WTrans Signature Month Day Year <br /> W ger I PrintedrTyp d N me/ <br /> (n <br /> 0 <br /> Z Transporter 2 Printadfryped Name I&VIetalri- Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity Type ❑Residue 7 Partial Rejection El Full Rejection' <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA 10 Number <br /> :3 <br /> 3 <br /> � Facility's Phone: Of <br /> LO 18c.Signature of Facility(or Generator),,' <br /> LJ Month Day Year <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W <br /> 2. 71 4. <br /> 26.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> PrIntedfTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) PreVioUndItions'are obsolete. DESIGNATED FAciL+f4' -TO GENERATOR STATE'(IF RtGUTMED) <br />