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t <br />Please print or Mm. (Form desioned for us on elite (12 -aitch) newri er.l - dnnr ".A MAO K1- vnc mon <br />EPA Form 8700-222 (Rev. 3.05) Previous editiorj are dbsolete. - TRANSPORTERS COPY <br />ffJ <br />ITAL <br />ENT <br />UMFORM HADMOU$ 1 1. General r 10 Number <br />2 Page 1 of 3. Emergerzy Response Phone <br />4. TihnYest Tracking Number <br />WASTE MANIFEST , C A D$ S r Q� 30 2 0 7 <br />0057 <br />5. Generator's Name art Mailing Address Generators Sae Address (if diRerent Dart ma6rmg address) <br />irltlM PACfM g , C.G. <br />snr -1� FOOTHL S n 3? E. +M S"TrdmT <br />'"FPsUE CA 967 STOCKTON r.6 -8.106 AUG 02i ? <br />:. ---------- _-;am/Nan US.EPA 10Number ENV{RQN{'19{E <br />2_-T-----=---- -- — ------- U.SEP <br />U.S. EPA 10 Number <br />FxWs PWw. z ., <br />ga. Class, bhum.=;, C. Conracmers 11. T63I 12. Unit 13. *as a Codes <br />HM and >: - _ :. No. Type Quantly WtAti, <br />0 <br />H <br />095 <br />DU <br />, <br />W7 <br />3. <br />4. <br />14. Special Handing Imaudbrs and Add Son I Inbrtretlon <br />�$Y.? "QiuT �f �"+T• P�b"E3�_''°"a.}S 'k 5�d �-:9E.� ?ix �i.C,.�.'i2r`:�' ��r � �1C'';x _^,,�,°i.�_T"° <br />ERG IIIc <br />MC-2NCY COW' A= CEM4 sRXC -3.300 <br />s 5. GENERATOR'VOFFEROR'S CER TION: I hereby declare that the =Ment of Oris condgnmen; are My and accuraetaN described above by the p mw shq*,g rave, ars are classified, packaged, <br />marked and labeled/placarded, and are in an respects in piper cond'Oan for.'ansron acmrJ ng to appkaola Intema"c and naoona covemmental reguladcns. O export shipment and I am the Primary <br />COM <br />Expo tff, I -arh{y LI -at the contents of Ods signrmat conform to the terns d by atfadred e"FAAcMowl d mens dr:s <br />I certify that the vrade minimizallon staler, ent Identified in 40 Cr'•R 282.2T(a) (f I am a large qty ganerabr) or (b) (:f I am a srr:ll gm;ntity generator) is pus. <br />Generator's/Ofero's Printed/Typed Name Sigrea Month Day Year <br />i— <br />1 a.-Mmmaboft Shi <br />❑ imok Ito U.S. CI Effort ftm U.S. ?on of antry/exit <br />= <br />Transacrterslgmtm(fcrexpodsmiy): OateWaving U.S'.: <br />17. Trans—poner AcicoAedgment of Receipt of h alerials <br />Transporter 1 PrmtedfTyped Name Signabee Month Day Year <br />Y <br />Trmtsparter2Printe e <br />-` 0ar ear <br />OC <br />F <br />18.01scepanuy <br />II��II <br />18a. Discrepancy Ineiuw Space- Type ❑ Read. ❑ Partial'P,e;'edion l_J Full Rejection <br />— Hardest Reference Number. <br />18b. ANerate Facility (or Gener�.rr) U.S. EPA. I] Number <br />V <br />IC <br />U. <br />Fadfiy's Phone: <br />18cSgmtureOfAltemaleF_- :. : _-- - <br />McnL� Day Year <br />QW <br />2 <br />11 <br />19. Hazareota Waste Reaorl Mena g _ ;... ; d Codes (.e.. codes forriazardous wase treatment. disposal ar:d recycling systems) <br />20".td akrw or Operator mbon of reaript of hazamba rratarials covered by the mandest except as noted in Item 18e <br />PnnWTypedName ) Sf9raiOxa i WO* DayYear <br />EPA Form 8700-222 (Rev. 3.05) Previous editiorj are dbsolete. - TRANSPORTERS COPY <br />ffJ <br />ITAL <br />ENT <br />