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r <br />i <br />a <br />Please print or type. (Forth designed for uSejat eNte 02 -pitch) typewriter.) <br />0 <br />DTSC. 00678. 1813 <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3.05) Previous♦ dons a e oOselEste. p TY T DESTINATION STATE (IF REQUIRED) <br />10372.0091 <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />2. Page 1 of <br />P. Response Phone <br />4. Manifest Tracking Number <br />WASTE MANIFEST CAL9235041113 <br />1 <br />800-746.7"9 <br />003235988 JJK <br />5. GeneraWes Name and Mailing Address C eraWs Site Address (if different than mailing address) <br />SUMMT LOpST1CS,SSAFEWAY) <br />1 WEST SCHUCR RD. <br />TRACY. CA 85377 <br />Generatols Phone: 2MB33-4MO <br />6. Transporter 1 Company NameU.S. EPA ID Number <br />SWOP S SOLUTIONS 0848497 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facli[ty Name and Site Address GEM4tANCHO GOR A. LLC. U.S. EPA ID Number <br />11655 WHTE ROCK RD. 1 93 <br />RANCHO CORDO VA, CA 95742 <br />916-351- OM <br />Fadi s Phone: <br />ga. 9b. U.S. DOT Description (mcludirg Proper Shipping Name, Hazard (lass, ID Number, <br />10. Containers11. <br />Total <br />12. Unit <br />13. Waste Cedes <br />No. <br />Type <br />HM and Packing Group (it any)) <br />Quantity <br />WI.Nd. <br />1. <br />365 <br />P <br />D008 352 <br />® <br />) 0008) <br />Z <br />2. <br />us <br />3. <br />4. <br />14. Soeda <br />@ATTERYAGID DRY <br />YAPPROPRIATE <br />EI'lTB <br />PROTECTIVE CLOTHING <br />SEE ERG t1I171 <br />15. GENERATORVOFFEROITS CERTIFICATION: I hereby glue that the contents of this consignment are fully and accurately described above by the pry shipping name, and are classified, padr-qed, <br />marked and labeled/placarded, and are in all respects in mer condition for transport according to applicable intemational and national governmental regulations. If export shipment and 1 am the Primary <br />Exporter, i ce" that the contents of this consignment contam to the terms of the attached EPAAckrwwledgment of Consent. <br />I certify that tie waste minimization statement identified in 40 CFR 26227(a) (d 1 an a [age quantity generator) or (b) fdI am a small quantity generator) is true. <br />s Prknt�Typed Name Month Day Year <br />Ganer217,4 <br />J <br />16. Inhurudional Shipments ❑ Import to U.S. ❑ Export from U.S. Pat of entry/exit <br />Transporter signature (for exports only): Date Issuing U.S.: <br />17. TrahsporterAckn owledgment of Receipt of Materials <br />Tmn 1 Pr[ntedf, , Name Signa Month Day Year <br />a <br />Transporter P Neth My Year <br />F <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ 4opantity ^ ❑ Type ❑ Residue ❑ Partial Rejection ❑ Rdr Rejection <br />Manifest Reference Numb <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />to <br />u4. <br />' <br />FadWs Phare: <br />W <br />180. Signature of Alternate Facility (or Generator) <br />Month Day Yea <br />a <br />19. Hazardous Waste Report Management Method Com (i.e., codes for hazardous waste treatrnant, disposal, and m ydinq systema) <br />LU ® <br />i2. <br />AvA, ® <br />3. <br />4. <br />20. Designer FacB'dy Owner or Operate of receipt of hazardous materials covered by the man" <br />law <br />EPA Form 8700-22 (Rev. 3.05) Previous♦ dons a e oOselEste. p TY T DESTINATION STATE (IF REQUIRED) <br />10372.0091 <br />