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MERV Please print or type.(Form designed for use on elite12 itch typewriter.) ERJ 1111 ( ) e ) Form Approved.OMB No.-050-00399 UNIFORM HAZARDOUS 1'�� i 2 age 1 of 3 Phone 4.Manifest Tracking Number WASTE MANIFEST O�O O�� /47 5.Generator's Name and Mailing Ad LTb 1 #9830 Generator's Site Address(f rliRpleotJhaploailinp address) FILE 20995165+4 6632 Pacific Avenue 6632 Pacific Avenue Generator's Phone Stockton, CA 95207 Stockton, CA 95207 6.Transporter t Company Name i0 U.S.EPA ID Number Steric cle Sp ecialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name i U.S.EPA ID Number WT J 8,Designated Facil ty Name and Site AddressC"-D General Environmental Mgt, LLC u.S.MAIL)Number l� 11855 White Rock Road Rancho Cordova, CA 95742 Faa1ity's Phone: 9163510980 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, HM aril Packing Group(if any)) 10.Containers 11.Total 12.Unit No. Type Quantity yy 13.Waste Codes w X ti1N2811, Waste Toxic solids, organic, n. o. s, i CF (Chromium, Selenium), 6- 1, PG II, ERG#154 00003 P 311 D007 D010 W tz 2. on azar ous was e, solid (State 3 Regulated Products), DF 00416 P 331 3. 4. 14.Special Handling Instructions and Additional Information I. 100196(RX Toxic Solids ) 2. 102980(State Regulated Solids) 15. GENERATOR'S/OFFEROR':CERTIFlCAIII N: I hereby deGare that the contents of this consignment are fatty and accurately described abore b the marked and labeledlplagrded,and are n all respects in proper that for transport accadIn to a Y Prefer stupe ng name,arid are dassified,packaged, Exporter,I certify that the contents of tlHs consig anent conform to the terms of the attached EPAAd now ble nlemabonal and national 90 ntal regulabons.If export shipment and I am the Primary I certify that the waste minimization statement identified in 40 CFR 26Z27(a)(if I am a la edgrnent of Consent. neratofs/OflerorC /�� 'J 1, �quantity generator)w(b)( am a an q tity aerator)is true. G ay ear � 6.Inlemational Shipments r ❑Import to U.S. z Trans er si lure(for exports onl Export from U.S. Port of t 071 141 1 It 17.TransporterAcknowMReceipt of of Receof Materials Date leav n .S.: Transpo ter 1 P intedrTyped Name Kristo her ynature P Almanza I w,m Day Year Transporter2Printed/rypedName I 07I 141201 rgna r` onth Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection 18b.Altemale Facility(w Generator) Mardfest Reference Number. Z3 p U.S.EPA ID Number Q LL Facti s Phone: Q18c.Signature of Alternate Factidy(or Generator) Z Month Day Year 19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatmen di OW 1. t, sposal,and recydurg systems) 2. 3. 4. 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest excep Pr nteN as ed'm Item 18a d/i ti S gti Month Day Year Gq'C'e q EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. a ESIGN D FACILITY ESTINATION STATE(IF REQUIRED)