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FROM :STOCKTON GATEWAY 76 FAX NO. :209 9464762 Jul. 09 2009 02:11RM P3 <br />-Please t -7i Foam Awrovad- OMR Nn 96MLMM <br />- print or Noe. (Form desionod for use on aft (12-oitdil wombr.1 <br />GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />2. Page 1 oaf <br />3. Emergency Response Phone <br />MAPdfaN 7mwrtg Nuft*w <br />WASTE MANIFEST`Zj" (50ruLsw- a <br />1 <br />)20'26382 FLE- <br />f5j3eneraWK Name and Mailing Addreas Generator's Sile Address (if d1frerant than me"Ira edd— <br />Gelleralor's Pllone: Ddq AA ?1P1 <br />it. Ti".. vA*r 1 o97r;3;y Wme <br />U.S. EPA M Number <br />y �- <br />T. Transporter 2 Company Name <br />V.S. EPA ID NuMbB <br />11. MOM pz*—Name SM SAO Address <br />I).$, EPA 11) Wmbw <br />FadlVs Phow., <br />,4g. <br />8b. U.S. DOT Description (mcjuft Proper $NppN Name, Hazard Class, ID 14001W <br />10. conlalnem <br />11. Total <br />Unij <br />• <br />I lm <br />and Packing Gtoup (it any)) <br />Quantity <br />WW12. <br />I. <br />wage Codes <br />No. <br />Type <br />C9 <br />3. <br />e. <br />14. Special Handling InStrurt0n3 and Additional tnfbmmtion <br />15. GENERATOR'SlOFFE-ROW8COU711IMTION: I hereby duclare that the oonfento otbaconsignment we fully and accuratalydascribed above by ft prvpershipp4 norm, and are classilled, padm*. <br />marked and are In all respects in proper cqnMm for transport accoft to applicable hffn*rkj BM national govarrunental regulations. If export shipment and I am the Primary <br />Expxtar, Ice* IW the contents of ft. rzmtnnnwfflconfotmtothe wmofthe abrhMEFAAdmorAodgmntofConsent. <br />I Certify ULM Pie Waste rYliftiftVZatim statement Identffied in 40 CFR 26227(a) (If I am a large qwnlly gefleral0f) Or (b) (if I am a small quentily generator) is true. <br />PrintedffypedNams sowture -I- <br />mom Day M f <br />yQ�IS. <br />Intermilk"M slipfru"tis [3EVoqfro.U,S. Ponofelwavt <br />Transportet siqnature (to( OV06 ov�j: Data us.-- <br />11• •l ransmrlof Acknowledgment of Rem.0 of Kiledols <br />Transporter I PMVTyped Name --------- sweltire <br />O <br />Transporter 9 WntodfTypW Name <br />Month Day year <br />I <br />18. DimrPrAnty <br />16a. Discrepancy Indication Space ❑ Quantity ❑ Typo ❑ Residue <br />❑ P'ftt Mecwn 0 F -A Refed, <br />Manifest Retrenkg Nu bar. <br />16b. Alternate Facility (of GeAmlor) <br />Z3 <br />U.S. EPA 10 Number <br />63 <br />Faci <br />Ift=f AlIcniate Facility (orGeneratorl <br />Month —Ytar <br />19. Hazardous Waste Report W- naPm8nt Me#W Code$ (i.c.. codes for hazardous waste treatment, &4msA and rmy*V systems) <br />C2LAJ <br />mff4OL4inFVO(OV.�OW.CWVMSMOfMoeoof ha" <br />p$ mgtegja6- Wiered by the manifes: exccptas nofgd in Item 18a <br />F,,e <br />',�7.ted <br />owe <br />month Day ser <br />EPA Form 8700-22 (Rev 3.051 pelftvibup ad&lmr. am 1+e "ft <br />I <br />GENERATOR'S INITIAL COPY <br />