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Stockton Tri Industries Inc Record ID# PR0515670 <br /> 2141 E Anderson Ave, CA 95205 Program: HW <br /> July 26, 2019 <br /> PHOTO 13: Manifest number 016654495 JJK shipped date 4/11/17 Signed off by the designated facility. <br /> =rte <br /> J <br /> "sreaat Nandtmg mslmttlons aedaatlibprtm mrom,alme <br /> l5. GENERATOR'SlOFFEROR'S CERRFICATIree IM1ereby declare that me ronlnrs of Nis mnsignmem are fully and accurate)tlasuibabpveb Ue pm er shi <br /> arked and tabele0/placaNetl,and are in all respects in proper candiripn for vanspprt accortlin " <br /> Expprter.IcelUly lhal(heconlenra Dlthis ronsignmentconlortn tithe lentis of Ne attached EPAA anpwledgmenl of Cpnsenby yD PP]name.aro ary Gasere%c""'- <br /> IcertirymatlhewastemmimlLatjonstatement itlen4fiedin1.CFR the <br /> ,tiflamalaye goappllrabla inlmalianalantl nation."g--le,regulabane.Ife-,sniDrtxn1 an01 a+T'r F^rs�' <br /> Generalo(s/ORem(5 Pdnletl/rypetl Nam quantity generatprl or Ib)(i(i am a smau guannry generator)is <br /> e Signature b,�h, !ea• <br /> r 16,Intemalional Ghrpmen6 ��/� • <br /> Transporter gnsture if.,ex ports only❑Import to U.S. L <br /> Eapon horn U.S. Pon of enhyte.ail._ _ _ <br /> W 17 TranspodieAcknowlebgmenlot Receiptof Materials Dal leaving U''a:. <br /> C TGr!Porter 1 PnntetlR Name <br /> 0 Sl yre Day Year <br /> __ / <br /> rransponeraPdm RypedName- �. _ -- t? �" `l_k�--:� <br /> Lk <br /> � Grgnature Mon Dar Year <br /> 1f8 Dscrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue ❑PaN3l Rejection I�FUII Rei=clicn <br /> Iii Alternate Facility for Generator) Manifest Reference Number: <br /> U.S.EPAID Number <br /> U <br /> LL Facility's Phone: <br /> W ;so,Signature O/Allemate Facility for Generator) <br /> e Mont, Day Yeas <br /> 2 <br /> 7g.Hazardous Waste Report Management Method Codes he-codes for hazardous waste vestment,disposal,and recycling systems) <br /> LU <br /> -C.Desrgnaled FadliM Owner or Operator.Certificalion Of receipt ofhazardous materials Covered by the manifest except as noted In Item 18a 1 <br /> Printed Typed Name Signature P.1cnU D-y Year <br /> EPA Form 8700-22(Rev.3-05)PF�10vs editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br /> ��Nvrtac ream:1-bUU-456-SPILL <br /> Tricia Dai, EHS Page 13 of 13 <br />