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Please pant or type Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator 10 Numher 2.Page 161 3.Emergency Response Phone 4 1-M I Itt�clFing�u � <br /> WASTE MANIFEST C A P 0 0 0 3 0 4 0 4 8 1 844-334-2468 UU JU �vhhJ 11 JJ K <br /> 5.(-,ermratcr's Name and Lta!hn Address Generator's Situ Addross lif different than mailing address) <br /> PG&E MANIFESTS PG&E GTP R-1036 TRACY <br /> PO BOX 7640 37.75033-121.47930 <br /> SAN FRANCISCO CA 84120 TRACY CA 96304 <br /> Generator's Phone 92 5 2 2 4 - 3 6 6 8 <br /> 6.Transporter 1 Compan Nam,, U.S EPA ID Number <br /> PSC INDUSTRIAL OUTSOURCING LP iC A R 0 0 0 2 6 9 5 4 8 <br /> 7.Transporter 2 Company Name U.S EPA ID Number <br /> 8.pESiprlatedFacility W'ig8 SilrM66vA.LLC U.S EPA ID Number <br /> 11866 Vill ROCK RSD <br /> RANCHO CORDOVA CA 95742 <br /> Facility's Phone:916 351-0980 _ CAD 9 $ 0 8 8 4 1 8 3 <br /> ga 9b U S DoT Descriptio-(including Proper Shipping Name,Hazard Class,ID Nun Dei, 10.Containers 11.Total 12 Uni' 13.'Nas:e Codes <br /> H%l and Packing Group(if any)) No Type Quantity WI Not <br /> 1NON RCRA HAZARDOUS MSTE.SOUD 611 <br /> o ISOIUDEBRIS CONTP MgNATED NTH OIL44ESEL.MERCAPTAN) --— <br /> a 0 0 1 DM 00300 P <br /> ILL! <br /> z <br /> W <br /> 3 <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> 9B.1 492061 1X55 <br /> 116-1910-0008-J0002 Pil PGT1912116 <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,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 /> _xporter,I certify that the contents of this consignment co^form to the terms of the attached EPAAcknowledgmenl of Consent. <br /> certity that the waste minimization statement identified it 40 CFR 262 27(a)(if I am a large quantity genera tdi<?6t if I am a small quantity generator)is Ime <br /> Generator'slOfferor's PrintedlTyped Name Signature Month Day Year <br /> DAVID MOSER ON BEHALF OF PG&E 10 2 P 4 F 0 <br /> ! <br /> J It, Internabonal Shipments <br /> i— U Import to U.S. Export frorn U S Port of enlrylexit <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> ^7 Transporter Acknowledgment ofRecall ofMaterials <br /> !— Transfxrter 1 Prmled,Typed Name Signal,; Month Day Year <br /> co DAVID MOSER 0 2 4 0 j <br /> Menth DayYear <br /> Z Transporter 2 Prmted/Typed Name Signaure <br /> I <br /> 18 Discrepancy <br /> 18a Discrepancy Indicat on Space Cuan!ity Ty;:e ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b Alternate Facility(or Generator) U.S EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w I& Signature of Altornale Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19 Hazardous Waste Report Management Method Codes(Le,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 1 3 4 <br /> 0 <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> i <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />