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Z=Kyoor ed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 SD� e'ADnn� Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number y1i./ `Pleu�T JJ K 5.Gener me and 8s Generator's Site Address(if different than mailing address) B : _ FERAILOC P?t TEES SERVIGE Ian ' 2Fvr?»9Rw1C STOCKTON,CA 95206 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number l ENVIRONMENTAL sERMC ES*C 1515 SOUTH RrVER IM WEST S&CRAMFNTO.Cs 95f91 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. O u z 2. Lai c� 3. i 4. 14.Special Handling Instructions and Additional Information 9E11)PROFILE* ERfl-M 11 1 -Re-ss o l HANDLERS T(` !x ',E APPRMTO PPE. 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year J 16.International Shipments � El import to U.S. ❑Export from U.S. Port of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O a QTransporter 2 Printed/Typed Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Typej j ❑Residue Partial Rejection Full Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J U u Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Ybar tZ- N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERA FOA