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Please print or. type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br />UNIFORM HAZARDOUS 1 Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Menlfest "Trac in Number <br />WASTE MANIFEST CAL00032. 1 1-000-466-X760 76D 1 <br />5, Generator's Name and Mailing Address General Site Address if different than mailin address) <br />WESTERN FARM SVC INC WESTER14 ARM SVC 19C <br />1905 N BROADWAY Fri BOX Buil 1755 yN BROADWAY ST <br />�v�e rrm rima CA 9520 5 Pq 19p.5188 5188 <br />Generator's Phone: 209-547-2600 a UG 0N Qft p zou <br />S TEMS, INC. U.S. EPA ID Number .1.XR 00005(}930 <br />7 TrapspoftQr 2 Company Name U.S. EPA 10 Number <br />8. Designated Facility Name and Site Address. Fit' ETY"'1iLrwE14 SYSTEMS. INC. 000760 U.S. EPA ID Number <br />6000 VOTH STREET <br />SACRAMENTO CA 95928 <br />5�1 &w3t36 1 CAtlOCrOO8 4517 <br />Facility's Phone: <br />9a. 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)) No. Type Quantity Wt.Nol. <br />X 1W;ASTE PAINT RELATED MATERIALel LIM1 63, DI"! P F003 D001 D018 <br />0 RG IIr <br />0035 D039 212 <br />z 2. <br />3. <br />4. <br />i <br />14. Special Handling fnprucfions and Additional Information St< TRCKOJ I0507 621 0039892397 0000369976 0919.2# <br />ttK AUTHO .I D .T T tfs LLC N ItD SUBSEQUENT;ARRIERS AS <br />15. GENfRATORtSIOpF RO `$ G, , IFICATION: I hall declare that the contents ffiis consignment are fully and accurately described 86ove by the proper spipp hg,no a or classified, packaged, <br />marked and Ialbeladfplacardeq 1prid are in,ell respects in prpper.co0dlfiob for;transport according to applicable international and national governmental' regulations! If export$hipmenl and f am the Primary <br />Exporter I certify tliarthb eoritents of this Jnr ignmi conform to the tabs of the attached EPAAcknowledgmegt of Consent. <br />I certify the( the waste minimization statement identified in 40 CFR 20.27(s) (if I am a large quantity generator) Drib) (if I am a small quantity generator) is true. o ih i Day Year <br />Generator's Qf%ror's.Prig(polTyped Nave ; ars ' e Signature <br />:: 16. internationa S t e# -,El from US. .Port of entrylexit: <br />I— , ❑ Import to U.S. N� <br />= Transporter signature (for exports only): Date leaving U.S.: <br />w 17. Tran er Ackno edgment of Receipt of Materials Moht " DaYr� Y r <br />t2 Trans rter 1 "P me yped ame Si ure' <br />O <br />d Mo th Day Near <br />QTransp n e Type Name Sign <br />18: Discrepancy ., .. �,." . <br />18a, Discrepancy Indication Space El Qual El Type <br />El Residue <br />❑ Partial Rejection ❑ Full Rejection <br />t. Mhn'dest Reference Number: <br />, U.S. EPA ID Number <br />18b. Alternate Facility (or Generator) <br />J I <br />tai Facility Phone::" Month Day Year <br />w 18c. Signature of Alternate Pal (or Generator) <br />a <br />Z <br />N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 4 <br />1 2 3. <br />4141 <br />20. Designated Facility Owner or Gator: Cerfificafion of receipt of hazardous materials covered by the manifest except as noted in Item 18a onth Day Year <br />Slgnatur ,< <br />Printed/Ty Name , <br />EPA Form 8700-22 (RTe�v. 3-05) a ous ed3'Iti'ns are obsol 4 DESIGNATED FACILITYTO GENERATOR <br />1)0012607 2 <br />