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Please print or type. 1.Generator ID Number Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST �+ -�� '�'�� 5.Generators[Jame arld MailinAfidre§s�}a IkA JJK Generators Site Address(if different than mailing_address) st.8®4raon St' at, Stockton, � 640 st.+�der Street Generator's Phone: 709-9-81- 956 _ Stocktm, CA Moe 6.TranspP9; 1�CEo pgy Name, U.S.EPA ID Number 7.Transporter 2 Company Name �*d kSte S U ib .S.EPA ID Number, 8.Designated Facility Name and Site Address .10y8 LL�� U.S.EPA ID Number 1855 White Rock Rd.-Raneho Cordova, CA 95742 Facility's Phone: (916)351-9O ga. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes 1�1 No. Type Quantity Wt.Nol. .. 'z?:SIO P&Wt R0141ted MMOdB14, 3,Pkv 4i O ( R 128) fQ- Ui Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information C US":wall powgiF*~Xh A"srvmci 6 X lis /Oi$Cs3s i;i r e x.fin 1N hM #*arM�fels an 0* a+ t'IHWTt c 1-400-4u," PAR 36910 15. GENERATOR'S/OFFEROR'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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if]am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments z11Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: of 17.Transporter Acknowledgment of Receipt of Materials w Transpo ter 1 Printed/Typed Name Signature O Month Day Year CL QTransporter 2 Printed/Typed Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ ❑ Quantity Type ❑Residue ❑Partial Rejection 1 ❑Full Rejection Manifest Reference Number: H 18b.Alternate Facility(or Generator) U.S.EPA ID Number U LL Facility's Phone: LOU 18c.Signature of Alternate Facility(or Generator) Month Day Year a z w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. -:73. 4. r20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY