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Please print or Form Apprayed.OMB No 2064-0038 <br /> • IFORM HA7ARb0U5 1.Generator ID lumbar 2.Pape 1 of 3,Emergency Response Phone Manifest Tracking dumber + <br /> WASTE MANIFEST CAL 0 4 0 4 4 01 4 6 1 (800)424.930Q0203 <br /> J K <br /> S.Ge ralor'sNameandMaillag ddrO Genaratm S*AddressIt4i6eraatltianmeilmgaddress) <br /> �iIIZMANS A11T0 EPAIA•al1ZD03 <br /> xO37 W.YOSEMITE AVE <br /> Mill CA 95337 1037 W YOSEMITE AVE <br /> GereraloesPhone: 20928&2616 MANTECA CA 95337 <br /> "r e.Trenspa!sr 1 Ca ENNViRONMENTAL SERIES �s CAA 0 2 8 277036 <br /> 1MV <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> e.De oLrDac iL R a�anid Site Acidness <br /> a U.S.EPA fD Number <br /> 2DOO N.N AMEDA STREETOOMCA 13022a <br /> CATOBOO13352 <br /> Fadi 's Phone: (310)537-7100 <br /> ga, 96.11,5.D0T DesWplion( udi <br /> ndng Proper Snipping Name,Hazard Class.ID Number. 10.CUM.aileis 11.Total 12.Unit 13 Waste Codes <br /> HM and Paddo9 GrouP 0at+YA No. Typo Quantty M Nor. <br /> ce I NON-RCRA KVARDO0 WASTE,LIQUID(OILY WATER) Iger <br /> o 0M 5d 0 <br /> x [J <br /> LU <br /> a <br /> 4. <br /> 14.*c1al Handling InsmrcliM and Additional Inlor na w <br /> EMERGENCY CONTACT:C14EMTREC I-SOD-424-9300 WOES TERMINAL CERES CS NAERGO 981:171'PROFILE 0 Oft: <br /> 484235 OILY WATER* OrAPPROPRiATE PPE EQUIPMENT }� j <br /> 15, GENERATOWSIDFFEROR'S CERTIFICATION:I hereby declare that the contents of ads oansignmenl are Fully and accuraW dawAbed above by the proper shppkg name,aryl are classified,packaged, <br /> marked and labeletllptacarded,and are in all respects in proper oonditon for traspcd according to apptirabta intemationaland nations)govemrwtal regulations.If axport shipment and I am the Primary <br /> Exporter,I os"that the contents of[his consignment conform to the Semis of the attached EPAAanowkedgment of Conseft <br /> t carely that Ihewasle mnimi kDri stalement idennhed in 40 CFR 262.271a)(if I am a large quantity generator)or(b)(rl arrye fl quantity generator)is true. <br /> GeneramislOdemr's PmjMfTyped Name signature •r Month Day Year <br /> yy, 1 <br /> t i I 1 <br /> 16.Intem Aonal shipments <br /> Ej Import to U.S ❑Fvpadhomtl.S. Podafentrylebt <br /> Transporter signatine(for exports only): Data leafing U.S.: <br /> RE W 17,TranspalerAckno"raem of Receipt of Malerial5 <br /> Tmnsportaf 1 Pnnadltyped Name Signature Month Day Year <br /> gk-� r .,I ) . .,4 <br /> V) <br /> Transporter 2 PnnreMyped Name Slgnature Morrth Day Year <br /> H <br /> 15-Discrepancy <br /> 18e.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejed. <br /> Manifest Relerencs Number. <br /> 18b.A11emate Factihy(or Generator) U.S.EPAiD Numb% <br /> J_ <br /> r.1 <br /> Fadlity's Phone: <br /> �a 1k.Signature ofNfemateFacility(or Generalor) Monti Day Year <br /> 2 <br /> y19.Hazardous Waste Report Management Method Codes(ie..codes for hazardous waste trea4nent,disposal and recycling systems) <br /> Lu <br /> 1. 2, 3 4. <br /> 20.Designated Farelity Owner or Operator Cergication of receipt of hazarvous maWA covered by the manifest except as nded in Dem 18a <br /> PnnledTTy*Name Signature Momh Ray Year <br /> EPA Form 8700-22(Rev.12-17)PreNous editions are obsolete. GENERATOR'S INITIAL COPY <br />