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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I.Gen r for Ib N m er 2.Pagg 1 of 3.Eme cy€� Dose Phone 4.Wnifest Trac ' g Number <br /> LC3 03394#3 f1 t4 d7-90- 02... 922053 JJK <br /> WASTE MANIFEST <br /> 5,Genet**I ip n ttjrj � INC„LF 00.P Generator's Site Address(if different than mailing address) <br /> 745 8 LIUCOLN ST <br /> STOCKTON 209 465-0444 CA 95203 <br /> Generator's Phone: <br /> 6.Transp �&U IWRCJNM ENTAL SERMCES U.S.E u � <br /> 8 T§1827703, <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Desigt�YeLaitlrrdss U.S.EPA ID Number <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 C A 7 0 c8. C O 13 3 5 2 <br /> Facility's Phone: (310)537-7100 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13_Waste Codes <br /> No. Type Quantity Wt.1Vol.� <br /> 644 aro <br /> z : �2. P%FM2ARDO :i VM,TE, UQUIC WrIER; <br /> LU e1 a <br /> /0 <br /> G <br /> 4. <br /> 14.Special Handling Instructions and Additional Information ' <br /> CONTACT: CHERIITREC 1-800-424-9300 WOBS Tti_RK L:CERES GS NAF-RG*961 :171,91132-x.71.X383:1 � <br /> PROFILE#9132 :M8MLFW0U1 MACHINE COOLANT,9132: LFW001-060820 OILY WATER,963: L 001-SOLVENT IV14ML <br /> SPIRITS '� *APPROPRIATE PPE EQUIPMENT <br /> 15. GENERATOR'SIOFFEROR'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, <br /> marked and labeledlplacarded,and are in ail respects in proper condition 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 terns of the attached EPA Acknowledgment of Consent. <br /> 1 certify that the waste minimization statement identified in 46 CFR 262.27(a)(if I am a large quantity generator).or(b)(if i am'a small quantify generat6r)tis true, <br /> Generator'sl0fferprs Printed/Typed Name : y Signature Month,: Dayy Year <br /> 16.International Shipments <br /> F ❑Import to U.S. ❑Export from A Port of entrylexit: <br /> ? Transporter signature(for exports oniy): Date leaving U.S.: <br /> I= 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 P6ntedfryped Name -e Signature Month Day Year <br /> 00 <br /> zTransporter 2 Pdntedfryped Name „. Signature Month Day Year <br /> 18-Discrepancy <br /> I 8a.Discrepancy Indication Space ❑ Quantity <br /> 11 Type ❑Residue ❑Partial Rejection ❑Fuli Rejection <br /> Manifest Reference Number <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> U- Faclilty's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a - <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ 1. 2. 13. 4. <br /> 26.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as ncfed in Item 18a <br /> Printed/Typed Name Signature Month Oay Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />