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Pleaso print or type. Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CA�.0=13 3 1 w&7B�722 1013305310 FLE 5.Generalor's Name and Mailing Address Generalor's Site Address(if different than mailing address) JIM 11 miLdacitong CO. 1051 Sony Ragd Stockton, CA 96208 j Generator's Phone: 209aaU-1 5 6.Transporter 1 Company Name U.S.EPA ID Number AdV3ncad GhemieW Trwmport kX,.IDRA ACTanWo (;,AARO=7a540 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number LIS Ecalcgy INs1R la WPO Rox 670. IS Reaixty T, 10 Beany, NV Facility's Phone: M-553-2 Da. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 14,Conlainers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WI.IVOI. 13.Waste Codes 1NA3077,HazArdous wasiv,ar:ui,mrr.u.(Chrcadum,lA�aM,9, 0M 181 DIX5 D 10 xa 0" Will LU 2. � 1 i 3. 4. I -:E 14.Special Handling Instructions and Additional Information Prt4ed NumW 2 Daicul hill[i s MR9269 1)E 171' 07012.8307-17'184,NU- r! 1 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare That the contents of this consignment are lolly and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,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 Expoder,I certify that the contents of[his consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if f am a large quantity generator)Q((b)(ill am a small quantity generator)is[rue. GeneraloeslOgerors Printed/Typed Name Signature: Month Day Year J 16.International Shipments F- 1-1 Import to U.S. ❑Expod from U.S. Port of entrylexil: ? Transporter signature(for exports only): Date leaving U.S.: I W 17.Transporter Acknowledgment of Receipt of Materials LU Trans po er 1 Pdn[edlTyped,Name Signature :+` Month Day Year IL 6 Transporter 2 PrinledlTyped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication SpaceI]I ❑ Quantity ❑Type El Residue El Partial Rejection -LJ Full Rejection � Manifest Reference Number: 18b.Allernale Facility(or.Generator) U.S.EPA ID Number J_ LL Facility's Phone: w 18c.Signature ofAllernate Facility(or Generator) Month Day Year a z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 0 1. 2. 3. 4. 20.Desgnated Facility Owner or Operator:Cedification of receipt of hazardous materials covered by the manifest except as noted in Ilem 18a Pdnledlfyped Name Signature Month Day Year i EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL,COPY