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Please print or type. (Form designed for use on eli a (12 -Ditch) tvoewriter.) Fn m On owl 0AA❑ ni,. once n EPA Form 8700-22 (Rev. 3-05) Previous editions are 6bsolete. I ) 400558/ "'VI 4601 1/ 7 499 4 GENERATOR'S INITIAL COPY UNIFORM HAZARDOUS 1. Generator ID Nu ber r 138-2 r;, w•AI�4_4. &a c=: 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Num"'b}er,ry �+ �/ 0 2 WASTE MANIFEST 8.10 81 0 V KS 5. Generatror's Name and Mailing AddressGenerator's Site Address (if different than mailing address) MCtw `4 E MARTIN L. li";"iER (T;Ni STOCKTON CIA 1:`r2V� 71 Generators Phone: --4fF,6-,H52 6. Transporter 1 Co'� mPan Name U.S. EPA ID Number `SAA c.r'Y'---t6�„--EDi ' vSTFr vJC;p I'N . 1`xRoo.00�r�` 30 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address t t' tzCOLDGY NEi1;Jtk / A ID Number I M I LES S OF-AEATT`V HWY 95 EATTY } riv a` --alm 800-239-3943 N V, r 13 300 121000 Facility's Phone: 1 oa 9b. U.S. DOT Description (including Proper ipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. P U09i., 0 1%CHROcM.I( M11 9 ;!tA'07 P 111 J � r . Z 2.NON RUA HA.CARi}OUS IWASIE LIQUIU, ! fit; - q RAGS, N-PIST I _ _ GREASE) 3. 4. 14. Special Handling Instructions and Additional Infor anon , sst .�, H I (O#n 0493Li078 54977668 371638 7 ��2t• Nli Eiji rita dyt Y I-0100 _ --1060 (SAFETY--KILEEN - "t.11*t'TRAC!• #k94'38) c� r"dt l"Hii r�i Tsi '?( Tt, i Ti^ fttCk j ,j1 �.ri113 ";' tp Cot t, Tr -tar- fi!; Mi "�:ti^ 15. GENERATOR'S/OFFEROR'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 resrects 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 consigrment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the 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. Generator's/Offeror'g Pnnted/Typad Name Signature t #r ,{ Month Day Year � ,� f `�' 1�;,��'f"�. 1s�"�! �; R..�"t""�"•1 ^ s' tri"t, �v"�"r'�' �"f(/ , " -1 H 16. International Shipments 3 ❑ Import to U. ❑ Export from U.S. f ; Port of entry/exit: z ; 1 Transporter signature (for exports only): Date leaving U.S.: U 17. TransporterAcknowledgment of Receipt of Materials Transporter 1, Printed/Typed Name Signature Month Day Year a- f 1 QTransporter 2 Printed/Typed Name R '"'Signature Month Day Year H 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantityy ElT pe El Residue ❑Partial Rejection Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number U Facility's Phone: wU 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z 19. Hazardous Waste Report Management Method Cod s (i.e., codes for hazardous waste treatment, disposal, and recycling systems) LU 1. 2. 1 20. Designated Facility Owner or Operator: Certification f receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are 6bsolete. I ) 400558/ "'VI 4601 1/ 7 499 4 GENERATOR'S INITIAL COPY