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Please print or type:(Form des red for use on elite 12- Rch)D2!writer.) Form Approved..OMP Ado. <br /> UNIFORM HAZARDOUS Generator ID Number 2, i of 3.Fmergertq+Response Ptwne. Ma est 7 ng Number <br /> WASTE MAAMiFES'E G gLCK}tT~� 55 7 f =.�-3aq.'7 1.i <br /> 5.Generator''s Name and Marling Address .,F GenerawesbAddress(gdi4emnt then maWim address).. ti <br /> MR,TVA <br /> SOK �rro XTX)N,CA <br /> STOCKTON,Gil-SMA <br /> Generaloes Phone: 1k- <br /> 8.7rensporter 1 CaiipanyNalrre•... - U.S.EPA ID Number <br /> 0' <br /> 7.Transporter2"Company Name U.S.EPA ID Number <br /> 8.De9aled,F. Nam and S9e Address U.S.EPA ID Number <br /> cit t ENVIRONMENTAL <br /> 11. - Adeu HEALTH DEPARTMENTCA 93W7 <br /> � .s <br /> Facil s PhaFa='t`.$ 1. r <br /> ess <br /> - <br /> t3:Waste9U S.DOT QpmhpinName Had gIDN _Containee 11.1otai .12;Unit Codes <br /> :.and Paddng Group(if arry)}•-:... -- :... _..- _ .. _,": .. : No: <br /> Type Quantity WtNoL <br /> oro v t MON RCRA'.`fi�.wf°C 0UV1AS M, yt'_11 rali��l sa�ri^,2tti� �1 .� p <br /> w 2, <br /> 3. 34, <br /> 4. <br /> 14.Special Handling Instructions and Additional Information ^ y r <br /> thi'v's'•rl a ` <br /> 71 <br /> 15. GENERATOR'SfOFFEROR'S CERTIFdlplICATION:t hereby declare that the contents of this consignment are fully and accurately described ave by the shipping name,and are classified,packa , <br /> marked and lebelescreded,and are in at respects to proper condition for tratusport—[ding to applicable intentional and national regulations.if export shipmnt and I am the Primary <br /> Exporter,I dartify that the contents of this consignment conform to the terms of the attached EPAAekmwledgmarrt of Con ea <br /> I ceriily that the waste minimization statement Identified to 40 CFR 262.27(a)Of 1 am a large quarltty generatori or(b)(ffl am a sort quantity generator)is we. <br /> Signature Montt Day Year <br /> Generatorsl0fferor's Noma �,-,�='� J.--... <br /> ..d 18.International Shipments -❑trtmort to n. -, El Export from U.S. Pot of antrylaxit - <br /> F= Transporter suture(for exports only): Date leaving U.S.: <br /> .17.TransporterAcknowtedtgmerd of Recelpt of Materials <br /> Triinsporter 1 PdRW Nam Signature Month Day .: Yaw <br /> a Transporter 2Printedffyped Name Solature Montle ..Day Year <br /> r <br /> 18a.Discrepancy indication Space E1 Quantity ❑Tye EIResidue ❑Partial Rejectors ❑Full Mae= <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) _ U.S.EPA ID Number <br /> Facilitys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> . Q <br /> Z <br /> w19.Hazardous Waste Report Management Method Codec(ie.,codes for,hazardous waste treatmert<,disposal,and recycling systems) , <br /> c1. 2 - 3: 4. <br /> 20.Designated Facility Owner'or Operator:Certification of receipt of hazardous materials covraed by the manifest except as nded in tem 18a <br /> Printedffyped Name f' Signature � fonts y Year .. <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. TRANSPORTER'S COPY <br />