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Plaa-*A ruird or tvnp !Farm rlaqionad for use an alita 112-oitrh1 Mewriter.1 <br />A.0 . 0:0;x.1,6- 24A- 2, ' <br />Form Approved. OMB No. 20SM39 <br />EPA Form 8700-22 (Rev. 3-05) Previous I S-81 DftaNATF_D FACILITY'TO DESTINATION STATF. (IF HF-GUIR1150) <br />10276.1405 <br />UNIFORM HAZARDOUS <br />Generator ID Number <br />Emergency Response Phone <br />king Number <br />0 0 3 235780, JJ <br />WASTE MANIFEST <br />CAU1235I54913 <br />-740-7449-- - <br />5. Germalors Name and Meft Address Generator's Site Address (if different than mailing address) <br />SUMMTLOGISTICS.,48AFEWAY) <br />16000 WEST SCHUL E RD. <br />...TRACY, CA 05377 <br />Generator's Phone: 209-833-4936 <br />6. Transporter I Company Name U.S. EPA 10 Number <br />SHOP HAZARDS SOLUTIONS - M 6497 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8.0 U.S. EPA ID Number <br />HV LLC... CAD 84183 <br />1,1W5%%"TE!ROCK:R0.-'- - <br />RANCH101CORDOVA. CA .95742 <br />Facilitys Phone: 916-351-0911),e -. <br />ga. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />and Packing Group Cd any)) <br />Quantity <br />WI.Nd. <br />-TO <br />N�CCORROBVEUGUM.-TOXC.N.O.S..8(6.1) UM922,111. <br />I — - <br />DF <br />P <br />0002 141 1 <br />. <br />Z <br />vi !&tCORROSIVEUQUDS.MC..INORGANC.,N.O.S..,B.UN3266.M,.,.- <br />I <br />DF • <br />P- <br />D002 141 <br />Uj <br />(Pa-hassiumCwboneb-,Potass�-qnHydrcxde)'DMZ <br />3. HAZARDOUS WASTE SOUD, N.O.S., 9, NA3077. IN (SILVER HALIDE <br />I <br />DF <br />P <br />352 <br />PAPER), <br />4. NON-RCRA HAZARDOUS WASTE UQUD. <br />-MF <br />P - <br />331 <br />(Diethlirleni glycol) <br />14. Special Handling Instructions and Additkutal Information <br />Ob/I -Pmfile #RlArX t photo chemical Drum #1 ERG #154, W-Pmffie #R "-A5-7r- PhOW Chemical, ERG #154 Drum #2; <br />M -Profile Wasiledwhalide phdo paper, ERG #171 D=413. ObM-PmM#A,Lt&f.,;,PhotD4Chemical, ERG #171 N <br />nQ11 <br />IS. GENERATORISIOFFEWS CERnRCA*nON: I hereby dadare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classillied, packaged, <br />marked and labeleftlacarded, and we in allIn accortling to applicable international and national governmental. If export shipment and I am the Primary <br />Exporter. I carlify t)d the contents of this co=me Lform to the term 't attached EFAAcknowWgment of Consent <br />:K40CFR <br />Ice *pfttthej10 minhkatim statement identified 1 1 2622;(a)1(d am alarge quanthygeruarator) or(b)(dl am asuer quantity generator) Is true. <br />wpm C Signatu Month Day Year <br />Ila <br />-.1 <br />16. Intern Import to U.S. U Export from U.S. Port of entry/exit <br />Trransporter xpods only): Date leaving U.S.: <br />119 <br />17. T—P(* Acknowledgment of Receipt of Materials At <br />Month Day Year <br />Tra; I Prin Name Signature IF/ <br />0 <br />Anth Day Year <br />Transporter 2 PrintediTyped Name Sigiature <br />18. Discrepancy <br />18a. Discrepancyindicalion Spam . El aurmuty, [:]Type ❑ Residue ❑ Partial Refection C1 Full Rejecti. <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />UV <br />Facililys Phone: <br />0 <br />18c. Signature of Alternate Facility (or Generator) <br />mom Day Year <br />Z <br />19. Hazardous Waste Report Management Method Codes (e., codes for hazardous waste treatment disposal, and recycling systems) <br />th q I <br />a <br />ph!j I <br />4. <br />I 1A <br />if ILI 1. <br />20. Designated ifacitly Owner or Operator Carifficem of receipt of hazardous materials covered by the manifest except Wnded or Rem 18a - <br />Prinlad/Typed Name Monttn Ye <br />In. <br />EPA Form 8700-22 (Rev. 3-05) Previous I S-81 DftaNATF_D FACILITY'TO DESTINATION STATF. (IF HF-GUIR1150) <br />10276.1405 <br />