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Please print or type.(Form designed-for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS j Page 1 of 1.Gen9mLw1D Number 2. 3.Emargar ry Ra;pc isu Phone 4.Manilest Tracking Number <br /> WASTE MANIFEST CAL00040037$ 916-371-5747 I 018790607 J J K <br /> 5.Generator's Name and Madfng Address GeneraWs Site Address(If citfereatthan mailing address) <br /> PACIM AVENUE CMWI! <br /> MW PAWC AVE <br /> STOCKTON.CA 95207 <br /> Getxaalro's I <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RAhtOS ENVIRONMENTAL SERVICESINC,7.Transporter 2 Company Name ( <br /> U.S.EPA lD Number CADD44OD3556 <br /> 6 C.> 1-Y,f--J 1, 1Z ( G p J_L—Z ,,SUSS <br /> S.Designated Facility Normo and Site Address PACM RESE RMOMY U.S.EPA ID Number <br /> 3160 EA9r P=OLVD. CA0008252405 <br /> LOS AVIMLE5,CA 90023 <br /> FacdB s Phone: MD-499-7145 <br /> ge. 50.U,S t1GT 0e&atdw(fridixIng Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> NM knliLcklttpQroup(ltamy)} 13.Waste Codes <br /> No. Type Quantity WLlvol. <br /> I UN1203,WASTE GASOLINE,3.PGO <br /> 0 G 331 D001 D018$ <br /> 0 <br /> ME 2. <br /> LU <br /> 0 <br /> 3. <br /> 4. <br /> 14.dip{tfar MN kmrri;ijof and Add.9arct Informstwn <br /> E-R L^t MRACM: RAws em AL <br /> �L s StiWW 8F'i D�APPROM PPE <br /> t 5. GENERATURSMFFERW6 CJEtTWQAT*k i her"docbm the ma CmAw s athm Cottefgnalent ate Lily 4nd ta=tay dasusbw'5bM by Me proper o*kcg arum,am om dmla d,Awia*, <br /> rr wW akf lahstfO�and are in d1 mpecin in v4uptr curdnim tr lett ara7rft to attfta$&s h44rnk=111 end ric"ppvW1mAttat ro ISAMix N and i am She Primary <br /> Ev",I tartly IttYf tho cofdcr>ts of pea mrrefgrttueart=*`m fz Mo canna df ft aftadxd EPA'Ack <br /> t M frit*Mtn filinhilan,eta�nar�iderealled in 40 CFR 28221(x)01 rxtt a Wo �or 141 I I sn a map 0urrrtiay m MWI <br /> Genet41;ii DActcr`s PnnbnYTjW Name Sigiwtu e <br /> tAutttf Day Year <br /> W I can <br /> .--i 18.Inlemabonai Shipments <br /> F_ ❑Import to U.S. ❑ from U.S. `p of entrylexll: <br /> Transporter signature(for exports only): Date leaving U.S. <br /> L= 17.TiansporterAwxrerwictti rnani of Receipt of Materials n <br /> a Tra q4 ) Month Day Year <br /> IL1i9 i i _' <br /> Q rransporter , SignaWm Monh Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Ouantily ❑Type ❑Residue ❑Partial Rejection ❑FuA Rycdien <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Fac6tyls Phone: <br /> C3 18c.Signature otA temate Facility(or Generator) Month Day Year <br /> a I I I <br /> z <br /> W19.Hazardaua Waste Report Management Methcd Codes(i.e.,erodes for hazardous vraste treatment,disposal,and recycling systems) <br /> Woo 12. <br /> 13. q <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item tea <br /> PnnlecYfyped Name r <br /> Writh <br /> Y r <br /> =PA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATLp FACILITY TO DESTINATION STATE(IF REQUIRED) <br />