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Please print or type. <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />WASTE MANIFEST CAR000289116 <br />5. Gener of Name a Dili Address <br />BSC IN �>a jailing ackton <br />3927 Clank Drive <br />Stockton, CA 95205 <br />Generator's Phone: Alb 940-3955 <br />6. Transporter 1 Company Name <br />Milwide Regavory Sg te» :Cam <br />7. Transporter 2 Company Name <br />Form Approved. OMB No. 2050-0039 <br />is 1 of 3. Emergency Response Phone 14. Manifest Tracking Number <br />00'alMtl' 00 020779068 JJK <br />Generator's Site Address (if different Ihan mailing address) <br />9927 Clark Drive Attn: jFrank Wilkerson <br />StOckt0n, CA 95203 <br />2730 s. ].BIY'$ sr>seag� <br />TMMr AZ 815865 <br />Facile sPhone: 925-844-0020 <br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (if any)) <br />1. <br />Yon-RCRA Hazardous waste Solid (Ximpty IPQ,Ly <br />Tank) <br />2. <br />4. <br />CM000175422 <br />U.S. EPA ID Number <br />A=000313924 <br />10. Containers 11. Total 12. Unit <br />No. Type I Quantity W1.Nol. 13. Waste Codes <br />C.300 It: 812 <br />Sill t0 mm Wrar ar0ger PVZ Clothing; **173 case of <br />426-9300 8esgiatrant #CC 97478*, 1000544529! P00505650 SXNZVG=y contact ClSillRRZC (800) <br />14 G� <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby d [are that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and iabeledlplacarded, 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 EPAAcknowiedgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I an a iarge quantity generator) or (b) (If I am a small quantity generator) is true. <br />.1 it). mrematronal Shipments — <br />Z ❑ Import to U.S. <br />Transporter signature (for exports only): <br />IX I 17. Transporter Acknowledgment of Receipt of Materials <br />18. Discrepancy <br />18a. Discrepancy Indication Space <br />❑ Quantity <br />18b. Alternate Facility (or Generator) <br />..r <br />V <br />Facility's Phone: <br />w 18c. Signature of Altemate Facility (or Generator) <br />Q <br />z <br />� 1 <br />LJ Export from U.S. 'PO—ftntrylexit <br />Date leaving U.S.: <br />Signature <br />Signature <br />❑ Type ❑ Residue <br />9. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 1 2• 3. <br />20. Designated Farslity Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />PrintedfTyped Name Signature <br />.PA Form 8700-22 (Nev. 12-17) Previous editions are obsolete, <br />❑ Partial Rejection ❑ Full Rejection <br />EPA ID <br />i9 <br />PNP0012765 <br />