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20 q . <br /> ow s I ned for use on elite pewriler.), <br /> Pleasflib(kype 12-plich)typewriter.), Form Approved.OMB No.2050-0039 <br /> UNIFOO WARD 11.Generator ID N)mber 12.nPa�",bf 3.:Emergenc7yR%e�s�ponse;P�ho—ne I Ak Manifest Tracking Number <br /> 0' A L, <br /> WASTE MANIFEST "0 0 4 4,M-03"13 <br /> I.�pgatzo?ffl,, allkg 6ddresj-�r_- JJ,K- <br /> UTF Gbherators Site Address If different than mallin <br /> 1 IUK C14�- _rR CENTERS <br /> address) <br /> PO BOX 3333 S. HIGHWAY, 9R <br /> STO�--M'ON CA er521' STOCKTON' CA 95215 <br /> Generaloes Phone: 2 3 7 3 0 Cl <br /> 6.Trarefti Co <br /> mtkapy-Na U.S,EPA ID Number <br /> F <br /> A Iq 1 7 "1 0 t 7 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> ASBURY SERZVICES JC4D028277013G <br /> I.Dep�faCljjql blypJ'agpbl_ff1dress <br /> U.S.EPA ID Number <br /> 2000 <br /> 8 3 5 <br /> ,Facility's Phone: 00 G A T 0 0 0 1 3 <br /> 537-74 <br /> ga. 9b.U.S.DOT Description(frickiding Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(((any)) 11.Total 12-Unit 13,Waste Codes <br /> Tye Quantity wtivol. <br /> (akBOLINEAMATBR), M34 D016 $43 <br /> UJI <br /> 3' <br /> 4, <br /> 14,Special Handling Instructions and Additional Information -17 <br /> il -777 7 <br /> ot <br /> TO BE ROHR TRALNIM A.1,TD USM3 PP& <br /> 0.1tro <br /> 15.',GENERATOR'SIOP,FEROR'S CERTIF�GATION:'I hereby declare that thebontents of this consignment are fully and accurately described above by the Proper Shipping naive,and bra classified,packaged;-LI-1 <br /> marked and labeled/placarded,and are In alf respects In proper ionditfi5h for transport according to applicable International and national governmental regulations;If expod'shlplmenj and I am.thd Primary; <br /> Exporte;'I certify that the'contents of this oqnslgnrnent cotiGrn to 66-terms of the attached EPAAcknovyledgment of Consent'' <br /> I'certf�thal the waste minimization stateme"ritidentillid InO.CM262.27(a)(IN amalarge quantity gagerator)or(b)(Iflamesmillquantlity-go' ' t')is <br /> here or true. <br /> Geperal&s/Offeror's Printed/Typed Name <br /> .,' <br /> 77 Day <br /> P4 <br /> (v-- <br /> 77 7Y <br /> T—Pal shipments EJ import to U.S. El Ewl from U.S, Port of entry/exit <br /> .Trahspod,ir signature(for exports only): Date leayinj U.S,: <br /> Uw17.1mns�orlerAdlm ledgment of Receipt of Materials <br /> i 9W //P'.. <br /> " Transporter 1 PrintedlTyped Nernst—, <br /> 1Z Signature <br /> 0 'N / y Month Day Year <br /> NP C A <br /> V) <br /> Z Transppjt,@r2 Printedfryped-Name Signat <br /> Month Day Year <br /> ur?.__. <br /> J11 <br /> �4 <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space Quantity Type 0 Residue F]Peru Re'Jection F,,lI.R.J.c'0o'n'.' <br /> Manifest Reference Number, <br /> Vb.Altomaite Facility(or Generator) U:S.EPA ID Number <br /> I LFar I 11itys Ph.n.: <br /> 18c.Signature of Allemate Facility(or Generator) Month Day Year <br /> (D <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> 2. 3.- 4. <br /> X Designated Facility Ownehor <br /> Operator:Certification ofreceipt ofhazardous-materials coyq <br /> (ad by,the Manifest ekq' <br /> In.1tom 18a <br /> PrintecliTyped Nabb— <br /> Slg�atur 1P a "Ye a r <br /> month <br /> EPA Form 8700-22(Rev.3-05) Previous editions-are obsolete," <br /> DESIG ATFD FACILITY TO GENERATOR STATE'(IF REOVIRED) <br />