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Compliance Report August 3, 2020 Store No. 1554— Stockton, CA Page 6 ATTACHMENT C Waste Manifest Please print or type. Perm Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator f0 Number 2,Page 101 3.Emergency Response Phone 4.Manifest Track' Number WASTE MANIFEST 'AF CFa(J �f7 04 ? t3E�Ei-:"85-72 2,5 014 T 5 5 0 51 ELE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) WaPo+t-,jt r upw ea,tmr 416,94 In;kt.r�r1. A 452 GeneralorePhone: =",1rL�1�! `•; 6.har spur a T�mparry h .�r Yf� �t 7�ti l i fUS.EPAID Nial, 0 1 t4 yj'rt 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number C-MifvedaC4f Tmosite-, S---+X Qaulk Awd filJrklifn,? ,? "=`I:Jt t11'N".7rr Modge to r_rr 141 15� Facility's Phone: m'i• R v_`+i'i 9a go.US,DOT Descril(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(If any)) No. Type Quantity Wt.Nol. 13.Waste Codes I. Nnlll,Crf{+Iit ,,N 0 1 �j,r1 ad z 2. w t� 3 4 14.Spec*]Handling instructions and Additional lnfomealion fh,_). -i! r.:. ;'I,', Ia '17 v ?`; 15. GENERATORVOFFEROR'S CERTIFICATION:I hereby declare[hat the contenls of this o4onnsignment are fully and accurately described above by the proper shipping name,and are dassifred,packaged, marked and labeladlplacarded,and are in all respects in proper condition for transport according to appilcable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform w the terms of the attached EPAAcarewiedgment of Consent. I certify[hat the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(IN am a small quantity generator)is true. Genem[ors101ferors PrintedlTyped Name Sign filum Month Day Year f' I 16.Inlemail l$hlpmunts F Import to U.S. ❑Export from US. )Pall of entry It: ? Transporter signeture(for exports only): DalaJ¢ava10 U.S.: w 17 Transporter Acknowledgment of Receipt of Materials -"--� e- -- - _ Traoapot[er PimtedlTyped Name 'f Signature, ., r Month Day Year- a z 1:1 Q Transporter 2 Pninted?ypod Name Signature - r MM Day Year I 18.Discrepancy 11 Discrepancy Indication Space ❑ Quantity ❑Type1 ❑Residue El Partial Re'aclion Full Rejection Maruiest Rearence Number, i~ 186,Alternate Faciiily jar Generator) U.S.EPA ID Number J U LL Facility's Phones LOU 18c Signature ofAltii Facility(or Generator) MonthDay Year a z V519 Hazardous Waste Report Management Method Codes(i,e„codes for hazardous waste treahnent,disposal,and recycling systems) 26 Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted In Item tae Pnnledffyped Name Signalure Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete_ GENERATOR'S INITIAL COPY APEX