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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.0M No.205Ga39 UNIFORM HAZARDOUS 11,Generator lD Number 2.Page 1 of 3.Frnergenry Response PhoneManifest Tracking Number WASTE MANIFEST CAL000022111 00--451-&W r- 008432839 JJ K 5.Generators Name and Mailing Address Genereloes Site Address(if different ban mailing address) Stocidon East Water District 6767 E Main Street 8787E Wain St Stockton,CA 95215 USA Stocldan,CA 95215 USA 9 Generators P 6.Transporter 1 Company Name U.S.EPA 10 Number Meza Environmentat Inc CAR000239327 7.Transporter 2 Cwnpany Name U.S.EPA 10 Number 8,Designated Facility Name and SdeAddressForward LandBit U.S.EPA iD Number 9999 Austin Rd CAL000190080 Manteca,CA 95336 USA Fa6htys Phone209-982-4298 ga. 9b.U.S.DOT Description(oduding Proper Shipping Name.Hazard Class,ID Number. 10.Containers 11,Total 12,Unit 13.Waste Codes HM and Packing Group(darty)) No. Type Quantity WtNol. X 1• RQ,ASBESTQS,9,NA2212,PGIII(ERG171) �, ] EIA y '151 0 7 Z 2. cs 3. 4, 14.Special Handling Irstructims and Additional Information Fri ableAsioestos containing materia Is waste prolile#9849 San Joaqutn Valtey Air pollution Control district 4800 Erde"se way Modesto CA,95356 (209)557-6400 Epa Region Region 9 75 Hawthorne St,San Francisco CA,94105(415)947-8000 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I herebydeclare that the contents of this const n metri are fully and accurately described above by Cie proper shipping name,and are classiced,packaged, marked and labeledlptacarded,and are in all respects in proper condition for transport according ro applicable Intematimaland national governmental regulations.It export shipment and t am the Primary Exporter,I certify that the contents of ft consignment conform to the teams of the attached EPA AdmWedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(x)(d I am a large quantity generator)or(b)(if I am a small quantity generator)is Lie. Generator"eroes Prowdrfyped Name Signature Month Day Year l.' C-,ohms �i—" e 1 --1 16.International Shipments T-- ❑Impod to U.S. ❑Export ton,U. . Port of entryfexil• Transporter signature(for exports only): Date leaving U.S.: 17.TransporterAdvrowWgnlentof Receipt of Materials Lu a T sponer t PrintediTyped Name Signature talo th Day Ye 0 14A U S - A, Q T&SPortar 2 Primedffyped Name Signature Month Day Year rlC F 16.Discrepancy 18a.Discrepancy Indication Space ❑ Chantfty ❑Type ❑Res due ❑Partial Rejection ❑Full Rejectors Mandest Relarence Number. 18b,Alternate Facdity for Generator) U.S.EPA ID Number J U tai Facilitys Phone: F16c.Signature ol'Al[emate Fadlity(or Generator) Morrlh Day Year d 2 19.Hazardous Waste Report Managernenl Method Codes(i.e..codes for hazardous waste Vestment,disposal,and recycling systems) 2. 3. 4. - 20. acility Own V or toftertificatim of * rdous materials covered by the manifest exoW as ]n Item 18a PrititedRyped Name Signature Month Day Year C V? I EI EPA Form 8700-22(Rev 3 } Preribus editio s are ob ete. DES NATER FACILITY ESTINATION STATE(lir REQUIRED)