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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 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 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) ALL STA14 HEAVY'I AL11.a i G4ilf*;. iNC 17M SOUTH ftp PMKWAY MANTECA CA 963:36 Generator's Phone: 209 933-7107 -6.Transporter 1 Company Name U.S.EPA ID Number WORL D colt~I`I R()NMFNTAL SE IFS 7 7 0 3 7.Transporter 2 Company Name U.S.EPA ID Number rAR ')00.1 75422 8.Designated Facility Name and Site Address U.S.EPA ID Number YUMA A?. 136-36111 Facility's Phone: (928),144,M2.8 93. 91 U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(ff any)) 13.Waste Codes No. Type Quantity Wt.Nol, 0 1. ,_ : ;..•.F i le WASTE.SOLIDS i.01t.Y'30L1M j z 2. w - 3. s 4. 14.Special Handling Instructions and Additional Information MERGENCY CONTACT - CHENITREC 1.800-424.03M WilliTEPMINAL'C FRES CS NAERa*981 171 *PROFILE 981 r',LL691-1$2f- NRS OILY.901-09 " *APPIOPPIATE PP'FQUIPMFNT .f 15. GENERATOR'SIOFFEROR'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 labeledlplacardea,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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratoeslCfferor's Printed/Typed Name Signature Month Day Year �j 16.International Shipments H ❑Import to U.S. ❑Export from U.S. Part of entrylexit: K Transporter signature(for exports only); Date leaving U.S.: L 17-Transporter Acknowledgment of Receipt of Materials a Transported Printedf yped Name Signature Month Day Year O CL rn Q T ansporter 2 PrintedJyped Name Signature Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: LLI 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z Fn 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 5700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY