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ease print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 11-6 enerstor ID Number 2.Page 1 of 3.Emer a Re onse Phone 4,Manif-ITncking Number <br /> WASTE MANIFEST CAL000294439 1 ( 0x)4149300 014057947 JJK <br /> 5.Genera "it"Ta"ress Generalors Site Address(H different than mailing address) <br /> 1648 E. HAMMER LN. <br /> STOCKTON CA 95210 <br /> 209 952-8760 <br /> Generators Phone: <br /> 6.Trans por+AB MMONMENTALSERVICES U.S.EpHlb"I 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> "Des1 <br /> g1%%v' fod.,SY6T#0LOGIES LLC U.S.EPA ID Number <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD097030993 <br /> Facility's Phone: (323)277-1500 <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 WUVd. 13.Waste Codes <br /> A. NON-RCRA HAZARDOUS L Y ) 352 <br /> x <br /> z 2. <br /> L <br /> 7 <br /> 3. <br /> �I <br /> 4. <br /> 14.Special Handling Instructions and Additional Inlarmadon <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#9131:171 *PROFILE#961:AP199195 OILY SOLIDS <br /> P500-00017650 *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT r� <br /> 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 classl8ed,packaged, <br /> marked and labeledlplecarded,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 minWzadon statemen!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. <br /> GeneralerslOfleroes P&Wrryped Name Signa Month Day Year <br /> 9�a r \�L /01a/ <br /> 16.Into al Shipments <br /> ❑InI Export from U.S. Port of enlrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Trans Iter 1 PrinteCyped Name Signature Month Day Year <br /> 'Transporter 2 Pdnted(ryp ISCigure Month Day Year <br /> C <br /> 18.Discrepancy <br /> 1 Ba.Discrepancy Indlcalion Space ❑ Quantity CITY,. ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> L Facility's Phone: <br /> 1Bc.Signature of Allemale Facility(or Generator) Month Day Year <br /> Y <br /> r <br /> 19.Hazardous Waste Report Management Method Codes(Le,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> U 1. 2. 3. 4. <br /> .1 <br /> 20.Designated Facility Owner or Operator:Certtfication of receipt afhazardous materials covered by Ute manifest except as noted in Item 18a <br /> FT, Typed Name *nature MF07 Day Year <br /> 1 <br /> r <br /> 'A Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />