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811 Zephyr St, Stockton, CA 95206 Record ID# PR0539941 <br /> Date of Inspection 09/12/2018 <br /> PHOTO 23: No TSDF Copy available for this manifest <br /> please pdnt or type.IFoo,designed br use on elite 112-pibhl typewriter I Form Approved,OMB No,20500-0039 <br /> UNIFORM NAZAROOU$ 1GeneralorlD Number 2Page l of 3.Emergency Response Phone I.Manliest Tracking Number <br /> WASTE MANIFEST FILE <br /> i � ��... _Addnas eneraW Add se ildifl Ihan mailing adtl��-.. <br /> US EPA ID Number <br /> s i.Jk,W,.Y+00)fIFiBQ <br /> U S.EPA ID Number <br /> 9DesryMdRtl FMI:r:V Name and Sile Adtlress <br /> U 5.EPA ID N.- <br /> -aa,F <br /> umber-aa,F W41Kd <br /> da91 kl� T tifA(XAt,'A FV.:7 <br /> A1 <br /> 9a. 96.US.—DestP.OndWing Pmper Shipping Name.Hazam Class.ID Number, 10.Containers 11 T°1a1 12.Unit <br /> aM Pac"Group pl a,Yll 13.Waste Codes <br /> - - No. TYPa UuanrilY WtNOI <br /> 1 <br /> 0 <br /> cp <br /> d_ <br /> aoo I .: la spaaal ng mswerpns anandd almmrmatoe <br /> ','Ser Wom:,�WrrrNaklr lOd ft,. <br /> 16._ad.,TOR'SIOFFEROR'S CER7IFICA710N:Thereby tleclare rhal the wntents of Ibis consignment are(ully and accurately describetl'boll by the <br /> marketl and labeleJ,blarardM,antlareina,i:e ett in proper condition for lranspodaccoNing 1p applicable international antl national <br /> ExPoReciceRgy Nat the anren6 otlhis wnsgnmenlconbrmtolhe terms of the attached EPAAcknowletlgmenl of Consent y proper shipping name.and are classified,packaged. <br /> I ttrOfy IM1sI the wash minimuaM1on staNmenl itlenkgetl in0CFR262.27(.)(i(I.mala g°vemmenlal regulations.Nexport shipment and am the Primary <br /> nereby rots nnl[d yp¢d erne rye quanM1ty generator)or(b)(itl amasmallquanlily generator is true. <br /> Igna 1 <br /> 16 rdems."Shipmenh onl ay e <br /> Transp""nature brei itsp I I❑Import"U's <br /> . US <br /> w ❑Export horn U.S. Port of entrylexit__ <br /> ,Odd,"IterAgn°wlro9manl°(Receiplol Materials <br /> TransPoRprl PRnIeWTYpmrt Name <br /> Dadele—U.S.: --------- <br /> imnsPoRer2 PdntedR ignature <br /> Yped Nam¢ i °nth aY <br /> eal <br /> Sgnalure <br /> 1 18 Diureronty <br /> 18a.Diacrepa,lntlirz-Space Month Day Year <br /> ❑Guantly <br /> ❑type Residue <br /> 186.Alternate Fadlgy(pr Generator( Partial Rejection <br /> O Manifest Relere Full Rejeclian <br /> 4 Fadli sPhpne. ce Number: <br /> W Ific.Sig-Use ofAllemale Facii U.S.EPA ID Numbar , <br /> Z Ily(orGeneralop <br /> �i9 Heiardpus Wase <br /> 1 1 Repoli Management Method Cods(i.e..Odes for <br /> hazartlous waste tr <br /> ezl <br /> 2. menl.disposal, Month Day year <br /> 1 1 i Designated F and recy�ng systems) <br /> acilily Owner or D 3 <br /> PnntdRypcd Name peratpr:C¢Nf¢.lipn olrec¢ipl of haiardpus materials coveredb <br /> EPA Form 6700- Y the manilesl except as noted in Item 13a 4 <br /> \ � <br /> 221Ray.3.05)Previous edict°na are obsolete. 9ignalure <br /> Month Day Year <br /> GENERATOR'S INITIA1 COpy <br /> Tricia Dai, EHS Page 23 of 24 <br />