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Please pnnt or type. Form Approved.OMB No-2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.EmergencyResponse Phone 4.Manifest Tracking Number <br /> f <br /> WASTE MANIFEST Cf I OV.1 i I [ �°RRG R u F <br /> 5.Generators Name and Mailing Address Generalars Site Address(if different than mailing a ress <br /> CUT Z ER LUMBER <br /> '10 RICKRRBAC.KIER CR 4004 S. EL DORADO ST <br /> Generators Ph LIV04MONE•CA 94 51 STOCKTON.CA 0522 <br /> 6.Transporter 1 Cb a m U.S.EPA ID Number <br /> (; <br /> 7-Transporter 2 Company Name U.S.EPA ID Number <br /> 4, <br /> 8.Designated Facility Name and Site Address U.S.EPA 1D Number <br /> Yt6MA YUy 2 1NA:;t l" I HF1N5FhK>At:ILi l Y AZR('k?052 I1H(y <br /> 6'bW U:�ItIIGHVYAIt'9) <br /> YS�`TvIA,Plc 853135 <br /> Facililys Phone• _r.. <br /> 9a. 9b.U-S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11-Total 12,Unit 13.Waste Codes <br /> HM and Packing Group tit any)] <br /> Na. Type Quantity Wl.Nol, <br /> 1. <br /> Q frlfW41-R[:FfAHA7ARf'i[-sllq WASTIF Sf;1 IIT Afi,-;0FtRF=?9-M P►1PF=k nil i 14A 11 F= <br /> 3 e1 <br /> FI1 TER'S 9 DIF BRI S <br /> Ll <br /> UJI 2. <br /> 0 <br /> 3, <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> i-rROMI-k# PAPER FILTERS ERr01 a1 <br /> EMERGENCY CON=F: flit I EE <br /> 15. GENERATOWSIOFFEROWS 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 labeled/placarded,and are in all 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 terms of the attached EPA Acknowledgment of Con sent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)dr•(b) mall quantity generator)is true- <br /> Generatarsf s P'ledlTyped me Signature Y r <br /> ir <br /> -J 16 <br /> .International Shipments __• <br /> I-- EJImpart to U.S. ❑Export from U-S- Porto enlrylexi -.__ <br /> F Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> t^ Tran 1 Priv ped Namy Signature, Month bay Year <br /> 2ETransporter 2 PnnledTfyped Name Signature Month Day Year <br /> F <br /> EDisc-repancy <br /> ndication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> .Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Facility s Phone: <br /> W 18c.Signature ofAllemate Facility(or Generalor) Month Day Year <br /> r <br /> x <br /> 19.Hazardous Waste Report Management Method Codes(i.e-,codes for hazardous waste treatment,disposal,and recycling systems) Notice. State of California requires <br /> O 1• 2' 3 <br /> generator to photocopy and mail to <br /> 20,Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Ifem IBe DISC with 30 days: <br /> Printed/Typed Name Signature P.0 Box 400 <br /> Sacramento,CA 95812-0400 <br /> EPA Farm 8700-22(Rev.12-17) Previous editions ars obsolete. GENERATOR'S INITIAL COPY <br />