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. <br /> Plow print or type. <br /> Farm Approved.OMB No..2050-M9 <br /> UNIFORM HAZgR�)n 1:Generator 1D Number 2:Page 1:bf 3.Emergency RespartsB Phone 4 Manifest Tracking Humser <br /> WASTE MANIFEST CAL000440057 1 t 877 i 577=2� � 013656995 F L E <br /> 5.Generates Name and Mail ng Address Generators Site Address(if differ ntthan malting address] <br /> routs#431. <br /> 999-9999 -250 E Ftarn ey. Ln 250 E Harney Lei <br /> Lodi, CA. 9524 L :d i,. :CA 95242. <br /> Generale s Phone: <br /> 6r.Transporlerl Company Name: -U.S.EPA Ip Number <br /> Stericyal,e Sp.eci.alt:y Waste SDjuti.ons Inc k'NS.0001.1 X324 <br /> 7.Transporter2 Company Name. U.S:EPA ID Number <br /> 8. <br /> oesig Wed Fapfily Name and Sits Address tan era n V ron m en U MgT., US.EPA II]Number <br /> 11855 White Rack Road <br /> Rancho Card va, CA '-357.42 <br /> Farili a Phone: <br /> ea_ gb•U.$.DOT Descdption(induding Prdper:Shippirig Name,Hazard Class.10 Number, tiff•(Unlalnsrs. l Total 12.Unit 13,vVaste'Cades <br /> HM end Pacldng Gioup(If any)). No.. T Quantity MN01. <br /> a Non :RCRA: h'azardaus Waste, liquid. (State 1 0008 p 331 <br /> Regulated Products),. <br /> ? .ikon RCRA hazardousiate.,. 5D :id (5tat.e 1 0007 P 35. . <br /> Regulated Products).,. <br /> 4. <br /> 14,Speoial.Handlog Inat unions and Additional lntormagm 1. 1113844(Stat a Rag u 1 at ed L i q u ids 2, 11084315t at:e .Reg u l at ed <br /> Solids) <br /> 15.. GEHERATORSIOFFEROWS CERTIRCATION:I hereby declare that t ie contents of this conslignment are fully and accurately describe above by the proper shfppmg name,and are classtfed,packaged, <br /> markad.aral Iabele %scarded,and are in all respedts tri proper condilia for transport accardfng to applicable International and natlorial g wrnmental regulations:N export shipment and I am the Primary <br /> Exporter,I oeriify that the contents of this consignment conform to the to Tns of the attached EPAAcknMedgm entatConsent. <br /> l eertify that the waste minimiiation sta9am M identified io 40 CFR262 (a}{'if t am a,large quantity genmW w(b)of E a small qua Gty..genaialor)'is true. <br /> s10ff Printedrfypad Nam .S Month flay Year <br /> 20 <br /> atlonalShipmeals <br /> ❑lmportw.11:S ❑Export from.U.S. Port of entry! ' <br /> Transporter slgnature.(for exports uply): Data taaving Lf. <br /> w17:Transporter Acknoviledgmal of Receipt of Materials Month Day. Year <br /> Transporter i Pdn1a&Typed Name Signature <br /> Johnny Harper 0 I 20 9 <br /> CL <br /> 24 Tramperlsr 2 PdntedlTyped.Name. Slgnahrre Month Day Year <br /> F <br /> 18,Discrepancy <br /> 18a,Discrapancy Indication Space ❑quant ty ❑Type ❑Residua ❑Partial Rejection ❑F01 Re <br /> Manifest Referents Nur bet.. <br /> tib.A{temate Fatuity(dr Ganeralor) U.S.EPA 10 Number <br /> � Faq[iry's Ptwne; <br /> iec signature.afAtiemaleFaclfilyy.(orGenerdtgr) Month Day. Year <br /> Q <br /> y19,Hazardous Wasle Report Management Method Codes(i.e:,codas far ous waste treatment,disposal,and reoyding sy§tems) <br /> LU <br /> 1. 2. 3. 0. <br /> ILA I <br /> 20,Designated Fadlity Owner oropaia m Cerllflcaliort of receiptol hand nisi materials covered by ttle:ma*St except as rented IslitmiA <br /> nn. ypad Nems Signature ManVl Da Year <br /> r � <br /> EPA Farm 8700.22(Rev.12-1 Fna ous editions are obsolete. DES(G ATED PACU EPA's.a-MA kFEST SYST <br /> ..-.... r.- <br /> 4 n..-2- r-b00t3OM-7 Clxi 8717- 1141 Ki!:DOlqt; M r"n atzi i Ct CnlalKll�i C7 <br />