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Plain— nfinr nr tuna <br />Form Approved- OMB No. 2050-0039 <br />EPA Form -8700-22 (Rev. 12-17) Previous editions are obsolete. UE5IGNA11EU I-AGILI I T I U hPA"s e-MANIt-tb I bTb I LM <br />UNIFORM HAZARDOUS <br />1. GeneraloR[uJu�b�r O S $ 2 <br />((.• IFS UU <br />2. Page 9 of <br />9 <br />3. ��g[gp%9!gnnse Phone <br />kJLi i- <br />4. Manlfest TrkNumber <br />1016114872 F L E <br />WASTE MANIFEST <br />5. Genffi&A2rR ftd'W TIONS - STOCKTON Ge1Xg% Vl W%bdgbjr ft (Ing address) <br />1325 EL PINAL DRIVE 1325 EL PINAL DRIVE <br />STOCKTON CA 95205 STOCKTON CA 95205 <br />408 9812 <br />Generator's Phone: <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />ALL CLEAN HAZARDOUS WASTE REMOVAL, INC. CAD 9 8 2 4 9 2 3 9 9 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designate' Facility Name and Site Address U.S. EPA ID Number <br />USE COLOGY NEVADA <br />HWY. 9511.MILES SOUTH OF BEATTY <br />BEATTY NV 89003 <br />NVT330010000 <br />Facility's Phone: <br />ga, <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol.792 <br />X <br />1. RQ, UNM, WASTE CORROSIVE LIQUIDS, ACIDIC, INORGANIC, <br />OF <br />G <br />lam! <br />O <br />N.O.S., 8, PG II (SULFURIC ACID. ALUMINUM] <br />OOC <br />L4 <br />Z <br />2. <br />LU <br />3 <br />1 <br />4 <br />_1 <br />1a. OMO &&'Tp nd�M 660 NMENT SLUDGE <br />-ACHWOOM121t211929T -CO " BILLTOALL CLEAN 1101 SN". <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 internationaland national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the leans of the attached EPAAcknowledgment 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 small quantity generator) is true. <br />Generatorsl0fferor5 Printed/Typed Name Stgnalufe Month Day Yeas <br />J <br />F <br />16. International Shipments <br />❑ Import to U.S. El Export fro S. Port of entry/exit: <br />? <br />Transporter signature (for exports only): Date leaving U S.. <br />17. Transporter Acknowledgment of Receipt of Materials <br />O <br />Transporter 1 PrintDatlypad Name Signature Month Day Year <br />CL <br />z <br />Trans crier 2 nntedfsyped Name _ Signature " !� Month Day Year <br />18. Discrepancy <br />18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility Ior Generator) U.S. EPA ID Number <br />J_ <br />L) <br />ta+- <br />Fadfi:Vs Phone: <br />W <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />a <br />z <br />U) <br />19. Ha ardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />G <br />1. <br />)�A (� ) ?h <br />2. <br />1 <br />3. <br />4. <br />20- Desrg ated a0r, Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Prin +Typed NameSg <br />onlih Day Year <br />"-w-4 <br />11)2 U' <br />EPA Form -8700-22 (Rev. 12-17) Previous editions are obsolete. UE5IGNA11EU I-AGILI I T I U hPA"s e-MANIt-tb I bTb I LM <br />