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rr IF <br />Please print or type. (Form designed for use on elite 12-pitch typewriter.) .. Form Approved. OMB No. 2050-0039 <br />UNIFORM HAZARDOUS <br />1 • Generator ID Number <br />9-j <br />WASTE MANIFEST <br />a411U. <br />JJ <br />5. Generatoes Name and Mai'mg.Address �; s Site Address (•d different than mailing address) <br />PRODUCTION CHEMICAL MANUFACTURING 'INC. <br />M 1000 E. CHANNEL ST. <br />STOCKTON, CA <br />Generator's P <br />6. Transporter 1 Company Name - kS-EPA iD-Nu <br />ENVIRONMENTAL SERVICES INC. <br />— <br />- <br />mpany Idents � �'� U.Sfity <br />PWtd <br />Name and Site Address U.S. EPA ID Number <br />�. PACIFIC RESOURCE RECOVERY <br />3150 EAST PICO BLVD. <br />LOS ANGELES, CA 40023 <br />FaciN s Phone:; 499.71.45 <br />ga. <br />9b. U.S. DOT Description (inciuding Prow Shipping Name, Hazard CIS, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />t3. Waste Codes <br />No. <br />Type <br />HM <br />and Panting Group ('d any)) <br />Quantity <br />WLNd. <br />O <br />t. NON RCRA HAZARDOUS WASTE LIQUID (OILY SLUDGE) <br />002 <br />0M <br />a,4-&P <br />G <br />343 <br />3. ' <br />4. <br />' <br />H <br />14. Special Handling Instructions and Additional Information® <br />Z <br />1)PROF 14,10006ERCM71 <br />INMONMENTAL <br />E.R.R: RAMOS <br />HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE <br />15. GENERATOR'StOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fuiy and accurately described above by the proper shipping name, and are classified. packaged, <br />'i <br />marked and labeled!placarded, and are in d respects in proper oo`nbon for transport according to applicable international and national govemmental regulations. if export shipment andam the Primary <br />Exporter, I co.* that the contents of this consignment conform to the terms of the attached EPAAcbwMedgmenj of Consent ` <br />q-1 certify that the waste minimization statement idenfi8ed in 40 CFR 262.27(a) (if i am a hinge quantity generator) or (b) ('d I am a small quantity generator) is true. <br />Ge retoes/Olferoes' mix! Nam Signature Month Day Yana <br />..r <br />16. International Shipments <br />?+,, Import to U.S. El.S. Export from UPmt of entry/exit <br />Transporter slgnaNre (for exports only)" Date leaving U.S.: <br />W <br />17. Transporter Adnowledgment of Receipt of Materiats, <br />Transporter 1 Printed/Typed Name Signature Month Day Year <br />1 <br />! <br />Day r <br />Tra tarUTyped Name Soars11 <br />�CO)?. <br />9 <br />18. Discrepancy <br />18a. Discrepancy Indication Space �y ❑ Type ❑ Residue ❑ Partiat Rejection <br />❑ Quan' ❑ FuA Rejectiat ' <br />,. Manifest Reference Number. <br />18b. Alternate Facility (or Generator) v U.S. EPA ID Number <br />'t <br />V <br />R <br />Fad ys Phone: <br />W <br />18c. Signature of FacrTdy (or Generator) <br />Monffi Day Year <br />4 <br />rAUurnate <br />Z <br />F) <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />® <br />1. <br />2 3. <br />4. <br />i <br />20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by Bre manifest except as noted to Item 18a <br />Prfnted/Typed Name Solab" Month Day ' Year <br />fKr (leGL-4 <br />EPA Fo 8700-22 (Rev. 3-05) Previous edttions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />11974.0262 <br />