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oi., ,.d..1 ... i C,..,,, daci—d fnr i lea nn olita 119—ifrhl ivnawrirar 1 Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number C A L 0 0 0 3 4 4 3 9 4 2. Page 1 of 1 3. Emergency Response Phone 18w 424-9300 oeww-- 4. Manifest Tracking Number 016711109 JJ K WASTE MANIFEST 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) FERGUSON 530 PORT OF STOCKTON ST STOCKTON CA 95203 Generator's Phone: 2 0 9 9 4 3- 8 3 8 7 6. Transporter 1 Company Name U.S. EPA ID Number FREMOUW ENVIRONMENTAL SERVICES INC C A R 0 0 0 1 7 1 0 1 7 7. Transoorter 2 Company Name U.S. EPA ID Number WORLDWIDE RECOVERY SYSTEM INC C A R 0 0 0 1 7 5 4 2 2 8. Des ar Eapilur hamelagd S to Address U.S. EPA ID Number HWY 9511 MI S OF CY 16 ACRES BEATTY NV 89003 Facilit es Phone: 775 563'2203 N V T 3 3 0 0 1 0000 ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity WUNoI. 1. WASTE CORROSIVE LIQUIDS, N.O.S., 941 1 D008 i D002 Ir X (RINSEWATER WITH LEAD), 8, II (D002) l '� LU W Z 2-N 44t X WI�H-LfkBIII l�ti/ 3. 4 14 Special Handling Instructions and Additional Information S 070137709-10310 / RinMwat9r With Lead /Corrosive ERM54jXUS 070137750-10298 / Rlnsewater with Le ER171 .( LJ . (2 5/,9- 31S krt' HANDLERS To BE 4ma mAmm AND IISE PPE. FR Conanct # 205907 011,121-1 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 labeled/placarded, 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 EPA Acknowledgment of Consent I tartly that to waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. neraloes/Of aures PrintedlT Name Sign 1 Month Day Year 17 v'. -a..) w - 105 lot 111 11crnationai Shipments Import to U.S. El Export from U.S. Port of entrylext: Transporter signature (for exports only): Date leaving U.S LU 17. Transporter Acknowledgment of Receipt of Materials �2 Transporter 1 Pri"fTW Name Signature Month Day Year a 07- 17 ZTransporter 2 Prinled(Typed Name ` Signature Month Day Year � � f � 7 � T 1�•-► ti 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantty ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J v ua Farilily's Phone: w t8c. Signature of Alternate Facility (or Generator) Month Day Year ZZ N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) C 1. � 2. 3. 4. 20. Designated Facltity Owner or Operator: Ce tion of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pnnted/T a mo S' t e M nth fay ear EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)