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DT5.C. 00.963 1:8.59 <br /> Please print or type.(Form des! ned for use on elite 12-pitch)typewriter.) ' Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generatre ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST 1 1 916.371.6747 1005487879 JJ <br /> 5.Generators Name and Mailing Address Generators Site Andress(d different than mntting address) <br /> UWED Mom w= <br /> 1932 EL PKAL <br /> STOCKTON.CA 98208 <br /> Generators Phare: <br /> zamna <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RAMOSENVIONWEIVAL SEMCES,INC. CA <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8. i n d F li Name and Site Address U.S..EPA ID Number <br /> ... <br /> SM1111 AVE. , <br /> CAMM=418, <br /> NEWARK,CA <br /> Facility's Phone: S10 10 <br /> gas• 96.U.S.DOT Desolption gndUding Proper Shipping Name,Hazard(lase,ID Number, 10.Containers 11.Towl 12.Unit 13.Waste trades <br /> HM end Padckx Group(N any)) No. Type Quantity WLAId. <br /> t <br /> W*R=KakROMS WASTE U=(OLY WATER J E) •_O I 223 <br /> I've- <br /> 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional Information <br /> MWLERS'TO BE TRAINED. 0/08 9b1)•ERG W 0171' <br /> �6T')0 <br /> 15. GENERATOWSIOFFEROWS CERTIFICATION: I hereby declare that the contents of Buis consignment are fully and accurst*descries above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all resper3s 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 Bre attached EPA gmentof Consent. <br /> I certify that One waft minimization statement identified in 40 CFR 262.27(a)(d I aa large quantity generator)or(b)(dl am quantity ge rator)is <br /> Generatersf0lferoes PdnteWyped Name .-. Signature Mon Day Year <br /> `,J '�lLa►kwt l O9 <br /> 16.International SM <br /> pmante <br /> �- ❑import to U.S. ❑Export from U.S. of entrylendt <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W17 Transporter Ad rimledgment of Receipt of Materials <br /> 12 Transporter 1 Pdnt ffyped Name Signature Month Day Year <br /> 2vs Sa � <br /> o A y Z. <br /> Transporter 2 PrintedlTyped Name Signature • Month Day Yew <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑quantity [--]Type ❑Residue ❑Par"Rejection ❑Fuii Rejaw n <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> Facility's Phone: <br /> w /8a.Signature of Alternate Facility(or Generator) Month Day Yap <br /> y19.Hazardous Waste Report Management Method Coda(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ® 1. 2. 3. 4. <br /> 20.l5esignated Fac�ilityyOwner or Operator Certification of receipt of hazardous materials covered by the except in ite 8a <br /> Printed/Typed t�rtreV v e <br /> uMonth Day Year <br /> cm .S <br /> EPA Form 8700-22(Rev.3-05) Previo(s/eeditions are obsolete. DE IGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10537.1588 <br />