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Please print or type. 111111111111111 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST i 013124255 FLE 5,Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 478--0891 660 W March Ln Generator's Phone: Stockton CA 5uc-07-6L::" 6.Transporter 1 Company Name U.S.EPA ID Number t ))4. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site AddresSGenera i Environment.-al Mgt, L_C U.S.EPA ID Number White l,` ck Road :t? CO" Ow'41K ` 742 Facility's Phone: 9a 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./Vol. Re a,;..., -� i__rt fat L.,L r ,.�., .. -'_• :i.:.;. - .:._r .. ,. O 3i.i C1 0 ERG#151 W '; I~2811, taste Toxic solids, organic, ri. 0. 5. 1 (D iChr omium, selenium) , G. 1, PG H, ERu#154 X JN1950, Waste Aerosols, Cf'iassable, (each not f; 7t 4. 14.Special Handling Instructions and Additional Information t C-4061-3(Gets.S-T.a 1 is 3e 4 t`,it i:t ii -1 or" "On,, ,i•e_', CNT . _; _. r t_ i -Q'za ,5.G1.42'iAe L �_ .s, srii+ ;;lei 15. GENERATOR'S/OFFEROR'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 1 am a large quantity generator)or(b)(if I am a small quantity generator)is true. Gene or'slOfferor's PrintedlTyped Name Signature Month Day Year International Shipments ❑Ex ort from U. Po of ent / it: F ❑Import to U.S. P ry ? Transporter signature(for exports only): D e leavin S.: 17,Transporter Acknowledgment of Receipt of Materials w nature Month Day Year Transporter 1 Printed/Typed Name IJ O z, w IL z Transporter 2 Printed/Typed Name S re Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U rai Facility's Phone: L11 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1 k /L-1 / I2. � 3. / 4. l✓ 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted m I em 18a Printed Sign Month Day Year Typed Name EPA Form 8700-22(Rev.12-17) Previous editions are obsoletei ESIGNATED FACILI�TOPA's a-M IFES SYSTEM PD04 @12'0 10