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006462858 SKS <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number r 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> x .. : . -.5 - 1006462858 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> a eedc�o Truck Labe #338 <br /> 3 99 At Jackstone Exit <br /> RIPON rA 953t";C-000 <br /> Generator's Phone: 209-599-7961 <br /> 6. 1 a a e U.S.EPA ID Number <br /> �Y- , Y`.'`1'FN t i SIC F';X�00,CA0 8 120 clx <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> -,4 ll-QNMENTAL SVC INC. MAI)O,-3"I3 2r a <br /> 8.Designated Facility Name and Site Address CI HARBORS WILMINGTON U.S.EPA ID Number <br /> 1.737 EAST D NNI STREET <br /> WILMINGTON , CA 9044 <br /> CAD04442983 <br /> 310-835-9998 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity wt./Vol. 13.Waste Codes <br /> Ce 1 NON-RCRA HAZARDOUS WASTE, SOLD =F=; <br /> o (OII.. SUERS) <br /> LL' <br /> Z 2. <br /> W <br /> U' <br /> 3. <br /> 4. j <br /> r <br /> s <br /> 14.Special Handling Instructions and Additional Information �. <br /> ^Es..s i PS, t f:F'`.•LTw>FO BY ��'FN T03 t?ETP d f°d LICENSED 5;U LPI IEE <br /> 15. GENERATOR'S/OFFEROR'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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b if I am a zmall quantity generator)is true. <br /> Generator's/Offeror's Pr me ed Name Signature Month Day Year <br /> ,� ) :EL21a S (I <br /> J 16.International Shipments <br /> z ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> 11, sporter 1 Printed/Ty d Name Sign Month Day Year <br /> N < .� 6 3 r <br /> QTransporter 2 Pr nted Name ignature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type El Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> �a+ Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLI <br /> 0 1t��I 2 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name � �Ln �-- FSignature Month Day Year <br /> j rA- �-1 I <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1)761200311567 7 <br />