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PlPsse print or type.(F rm des4ed for use on elite(12-pitch)ty(lewnter.) FO-Approved.Otv1B No.2050-0039 <br /> 1 UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone" 4.Manifest Tracking Number WASTE MANIFEST CA14SU74 I J J K <br /> 5.Generator's Name and Mailing Address O 11652227 <br /> C 4L TRANS(to)-STOCKTON b t 5 Generators%te Address(if different than mailing address <br /> PO Br3X 21)d+3 STOCKTCGi I h1 S <br /> STOCKTON,CA, 95ZI IJSA, 1a•34 SOUTri E b1F.ECT <br /> GeneratoesPhone�} SSG STOCKTCIdi,CA 95201 U.,S-. <br /> 6.Transporter f Company Name U.S.EPA ID Number <br /> Dttlard ERvlrortmrarltat senlcr#s <br /> CA.D +2523 is <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> 8 Designated Facility Name and Site Address U23 EC.0)6rgf U.S.EPA ID Number <br /> Htgllwa}S7 PI`tT'�w1:1 +3] <br /> .'.'f 13e31t},NRr �3rA3l1SA _ <br /> &X-234'-y9y3-2J <br /> Facilitys Phone: <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Container, t 1 Total 12 Unit <br /> and Padang Group(d any)) No. T,c- Quantity Wt,yyd. 13 Waste Codes <br /> I RC).,tA3077,HAZARDOUS WASTE SOW,f 1.Ci.5.,9 FU'iit. -' - 1. MAXo, <br /> o ICHP'D "U?J,LEAD PAir'JT CHIPS),(D0107,D008,), ERG# 171 <br /> W -QN! C. HAZAROOU S WASTE UQUID(WATER BASED _ <br /> PAP-IT.WATER) <br /> t <br /> 1 <br /> i <br /> apd� ���t�cgpos and Additional Information <br /> 4. dSHJrJG3:71t}talf� <br /> UA1E 1 <br /> LINE 2 WS# <br /> '21, ftp X� <br /> L GEN ERATOR'S;OFF EROR'S CERTIFICATION: I nereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping nave,and are ctassi5ed,packaged, <br /> marked and labeledtplacarded,and are in all respects in proper condiam 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 /> I testy that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(`t an a smail quantity generatcr)is true. <br /> Generatoesi0fferors PrintediTyped Name Sggair= n Ntcr.lh Day Yea <br /> SC1 . LAr�Cp�i1 r <br /> J 16.Intemaboaal Shipments <br /> ❑Import to U.S. ❑Export from U S Por•,of entry!extt. <br /> Transperer signature(for exports only): Date leaving U.S.: <br /> U-1 17.Transperter Advrowtedgment of Receipt of Materialst <br /> = Tranc r t PrintedlTyped Name Signare 1 Month Day Year <br /> CL L <br /> –1 t\j LL-r\,10k121 )5 <br /> QTransposer 2 Printed/Typed Name Signature Month Day Year <br /> H <br /> 13.Discrepancy <br /> 18a.Discrepancy Indication Space El <br /> Ouantiny ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest(Reference Number <br /> 1 db Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> �Q+ Facility's Phone. <br /> LLJ 18c.Signature efAlterrate'Facility(or Generator) 71-11 <br /> pay Year <br /> Z <br /> r� 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste trea rent,disposal,and recycling sys;_rns) <br /> 1. 1 2. <br /> �f03? T- 14 <br /> 20.Designated Facility Owner or Opera rtificabon of receipt of hazardous materials covered by the manifest except as noted in> 18a <br /> Printed/Typed Name ' <br /> SAr" ignori' hlo- aY� y <br /> EPA farm 8700-22(Rev.3-05) Pj ious editions are obsolete. ' DESIGDJ6TMD FACILITY TO GENERATOR <br /> A <br />