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La <br />. i <br />Plria;ke mint or tom. (Forum dL-joned for use on elite (12 -etch) tvoewriter.) <br />Form Aooroved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) M wnous eddim are obsolete. o DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />10392.1968 <br />UNIFORM US 1. Generator ID'Nun <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. . ++��,•�{{�� <br />WASTE MANIFEST CAO343253 <br />2 <br />( ) 32Er-1221 <br />9 23WAS <br />5. aerator s Name said fvW Address Generators Site Address f d' erem than ma ad�ess) <br />SEARS FULL Hs 0 1288 / LP sAkAGER SEARS FULL LAIR 0 12 / LP HARAGER <br />5110 -PACIFIC AVE 5110 PACIFIC AVE <br />STOCKTON., CA 95207 STOCKTON CA 93207 <br />. (2N)475 -65M . r OEJI a 11 <br />Generaron's Phone: <br />6. Transporter 1 Company Name Avq v►(e en" lco. ` oTCQ►7S -Orr U.S. EPA ID Nu 0 70 <br />FEEWNIM MNSPORT-9 faints—% S'i Ab-R+fib- IiIU9 8484'ttA <br />7. Transporter 2 Compprny Name ' U.S. <br />yE—P��A��ID Number <br />.Designated FaCilry Marne anti ite A�ess - U.S. EPA ID Nurmna <br />IGlr I 0 RTAL VICES, LLC <br />-M221AST STORMY ROAD AZDO81705402 <br />COOLIDG$, AZ 85228 .4 <br />Facility's Phone: (520)723-4167 <br />ga. <br />9b. U.S. DOT Description (mcluding Proper Shipping Name, Hazard Class, ID Number. <br />10. Containers <br />it. Total <br />12. Unit <br />13. Wane Corks <br />No. Type <br />HM <br />and Packing Group Of any)) <br />Quantity <br />WI.Nd. <br />o <br />X <br />RQ UN1993 USTE FLAMABLE LIQUIDS® R.O.Sa <br />3,0011, (PAIi'), (D001),ER0128 <br />if <br />j,�► <br />131 <br />Z <br />(' <br />X <br />2. <br />a <br />V <br />4'et�.4 to V75% &Asnr Aeeasds, ),1, Dool1 D03s) <br />®t bf: <br />50 <br />14. Special Handling Instruction and Additional Information <br />IAA Q458789GDR 2-U6_Q45879fl GDR 3eU6 Q458791_LDR y. � aq <br />a o% 1115579316- <br />15. GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare that;; comerdof this con 1 o are and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labetedfplararded, and are in all respects in proper condition for transport aaording t6 aofiralfe international and national governmental regulations. If export sh�r�f and I am Ude Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA`A&nowledgment of Conan. <br />II certify that the waste -y' statement identified in 40 CFR 262.27(a) (d I am a large quantity ata) or (b) fidI am a small quantity generator) is true. <br />eT <br />U'� sak .J < e month�`�-� ,aq y Year <br />v (. <br />J <br />16.I6ternaGomal Sfa <br />El Import to U.S. ❑ Export frrr' Pan.of entryfexit: <br />n <br />Transporter s' nahrre for LxM only): Dale leaft U.S.: <br />a= <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 5d+Name Month Dayegarr <br />IDS ®O <br />Transporter 2 Printed/Tay Year <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Reside ❑ PartMejectm ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Numb <br />U <br />FaclG s Phone: / <br />W <br />18c. Signature of Alternate Facility (a Gererata) Mort Day Year <br />4 <br />Z <br />US19. <br />Hazardous Waste Report Management Method Codes (i.e., crams for hazardous waste treatment, disposal, and recycling systems) <br />® <br />1. <br />H141 <br />2. 3. <br />—8ib�91..•_.., <br />4. <br />20. Designated FaaTty Owner or Operator Certification of rept W hazardous materials covered by the manifest except as rimed in Item 18a <br />PrffgedfTyped Name Signature Month Day ear. <br />lAyo4e, <br />EPA Form 8700-22 (Rev. 3-05) M wnous eddim are obsolete. o DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />10392.1968 <br />