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TO1600coc) t 'll 4a0 <br /> Please print or type. Form Approved.01MB No.2050-0039 <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CR4A3003E 1443 225-447-:i6613 o i � -.0 Lk1 r" t , G B F <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CAL If ORWiA 5T f E PARKS,CARNE GIE SVIRC :AST' <br /> R IViE:�=t MORE.,CA 945'56 TRACY.CA 95370 <br /> Generator's Phon fi:- � +' f+�' <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> iWLIl VALLEY WASTE Olt., WC. CAR0002723CI"r'. <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> W';3t'+tLLTWIOE frdF COVERY Sys fI<i s W CAR00017."22 <br /> 8.Designated Facility Name and Site Address U.S.EPA€D Number <br /> YarWA YES LLC <br /> 277;10 t:.. 1:iTf i tT Z11t S'f r ? <br /> YUIU&AY 85 365 <br /> Facility's PhoneSt:rf3-642431,x,36 <br /> ga 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) Na, Type Quantity Wt.Nol. <br /> 1. <br /> � N014:..f$c,FtA t•iA:?Afi'1:1C)(t'SWA.,i.';1'f- Sc?E.fl1 <br /> u� <br /> z 2. <br /> Lr,l <br /> C7 <br /> i <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> r�\�)'t/0 <br /> APPROF'RIAI•Ll.FROIECTIWF CL.01f 11146 Ei1FERGEPKW[,rC}M'ACT-DAVE <br /> ERG 0171 <br /> 15. G£NERATOR'SfOFFEROR'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 labeledlplacarded,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 /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity gerterg r &r b)(if I am a s all quantity generator)is true, <br /> Generator'slOfferor''sP.rifttedlTyped Name t Signature j` Month Day Year <br /> 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of eNrylexit: <br /> ? Transporter signature(for exports only): Hate leaving U.S.: <br /> 0: 17.Transporter Acknowledgment of Rece!V1 of Materials <br /> LLI <br /> Transporter 1 PrinteFfyped Name Signature �,.. Month Day Year <br /> l7 rix r� µ�� '._.._... J <br /> Z Transparter 2 Printedrryped Name Signature _ Month Ray Year <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ auantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F 18b,Alternate Facility(or Generator) U,S,EPA ID Number <br /> J_ <br /> U <br /> Facility's Phone: <br /> W 1 Sc.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba <br /> Pdntedlfyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />