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I111111111111111�11111111111111111 1111111111 11111111111111111111111 Form Approved. OMB No. 2050.0039 Please print or type. i 1. Generator ID Number 2 Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number + /� UNIFORM HAZARDOUS CGt tsL� t 447dit7 c._ l � = 1001039334 WAS WASTE MANIFEST S. G e�ralo Na(g� �r�dMeiry�g Jdrass � =i i '• l�f= � Pr� �` t4 � `� � e e�torrs, N. ('PL, , i th4,11011tg-1 ress�of?��yQrv, Nc— u�2 � J Sits { d 95 STOCKTON ,tsr , CA S't2t_ 3 . J2& Y J OO Generators Phone: U.S. EPA ID Number 6, Transporter 1 Company Name -`jTk5C % EXTRACTION _:LC DBA SRS TRANSPORT PORT � � _•� _ � i 7. Transporter 2 Company Name U.S. EPA ID Number I 8. Desi aajed-Faclr Namg apd Site Add a U.S. EPA ID Number ... ti .i. {•r•S �G � . 1 }Su = ,f ,....( -Tr;i ,. SE VAfit-�: Facitity's Phone: t i 723 �j_ ; 67 - ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Total 12. Unit 13, Waste Godes HM and Packing Group (if any)) No. Type Quantity WtNoi. a 1 ' NON RCRA HAZARDOUS WASTE SCtL11) ( DINZT ! 1 � � 24500 o llj , i r 4C'r 5. 4.:_ . ulu Z 2. W i I 3. I I I i 4. 14,Speclel Ha�dling �i�5>ruc i:ip and Additional information 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, marked and labeledrplacarded, and are in all respects in proper condition for transport accoKing to applicable Intemationaland national governmental regulations. If export shipment and I am the Primary I Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgmentof Consent. I certify that the waste minimization statement identified in 40 CFR 26227(a) (if I am a large quantity generator) or (b) (if m a small quantity generator) is foie. Month Day Year GZDto ene Signature 6. International Shipments El Importto U.S. ❑ Export from U.S. Port of entry/exit l Transporter signature (for exports only): Date leaving U.S.: j W 17. Transporter Acknowledgment of Receipt of Materials i ear LVnnspor i Prirt�dffyped Name / SignatureMonth Day YO �✓.i1{L r� eAr w da00rter2Printed/Typed me jot Signature Month Day Year r i8. Discrepancy l 18a. Discrepancy Indication Space quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. F- 18b.Alternate Facility (or Generator) U.S. EPAID Number } J V FadiiVs Phone: Month Day Year UO 18c. SlgnatureofAltemateFacility (or Generator) Q z N19. Hazardous Waste Report Management Method Codes Chat, codes for hazardous waste treatment, disposal, and recycling systems) W 1 i 2 3. 4. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Month Day Year PdntediTyped Name Signature DESIGNATED FACILITY TO EPA's e-MAIdIP'EST SYSTEM EPA Form 8700-22 (Rev. 12.17 ) Previous editions are obsolete.