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<br />)4Plcobo 5 83.1. _ . GENERATOR I UNIFORM HAZARDOUS
<br />WASTE MANIFEST
<br />1.-Generator ID Number , .
<br />C A C 0 0 3 1 0 8 7 1 , , ,
<br />2.Phgejbf4I
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<br />ergency Response Phone
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<br />112 ••
<br />4. Manifest Tracking Number
<br />O 2 1 JJK 6 9 2 9 r. ) ,
<br />5. Generator's Name and Making Address
<br />Hotly Commerce Center, LLC AtOldelliii
<br />231 Lafayette Circle, tr2oo f
<br />Tracy CA 94.549 :.1"
<br />Generator's Phone: 9 2 5 2 8 3 - 8 7 7 7t.,,,,
<br />1 4,4,..i.:6; %Site Address (ff different than mailing address)
<br />'7' .7 Center, LLC r Lk " 04 45 . er:••:!• Hoy Drive
<br />
<br />r-':, * \ "" '? • 95403 k i, , 4it, „ ti \I .. -...1
<br />Transporter 1 Company Name , k
<br />NAm 6,L1
<br />'nett ,,-•
<br /> ‘5 ,...t`IF. v.... U.S. EPA ID Number
<br />oh,:ii,1,...4.1:!J.,-,4,.. .- t,,,,,,:..y,,i.,.... I CisR000tp/-7V0
<br />Transporter 2 Company Name - U.S. EPA ID Number ,•1. , ....:.
<br />- I t,lylk
<br />8.
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<br />... , .,.,e. ,.P ELITI .11 : •nd Si i • .dress •,.. „,4, 1:1, , U.S. EPA ID Number
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<br />:•;.; • . .307, .-4, :4 i's f. : win Pi C_fav N'T 4..A i.3 taF.11-4-
<br />1 9S -56 S.. Avv6 I a A 2 e000 506990 ,44 , cA 90,742 -4., .
<br />vvfrIA Al 85365
<br />Facility's Phone: 3113-53T-7100Q1) -1 6 n
<br />,
<br />_ --1 co _ -2., 88 9 I . k, --T-8-4-0-0-1-3-6-6-2 b
<br />go. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. To .1 12. Unit 13. Waste Codes HM am Packing GrotiP (if ailY)) ' No. Type Quantity WtNeL
<br />1Non-RCRA Hazardous Waste, Uduld (OH & Water Mbdure) 223
<br />0 d 1 Tr 90, • :6 G
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<br />'14' -Medal Handing totructions, 1 IfhrIllil....i. . ' -
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<br /> 9D- j.., - ca.!. & a. nix • re c _
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<br />Invoice Costera Waste & Environmental,.Inc. i .1.' I
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<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, an] are classified, packaged,
<br />marked and labeled/placarded, and are In al respects,In proper condition for transport according to applicable intematianal and national governmental regulations. If export shipment and lam the Primary
<br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent..
<br />I certify that the waste minimizakon statement identified in AC FR 26227(a) (if I am a large quantity generator) or (b) (rfl am a small quantity generator) is true.
<br />Generator's/Offerors Printed/Typed Name fri Signature Month Day . Year
<br />..riv I
<br />i401-11- I 3 I 1 / I_ zi riray ' , „a
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<br />16. International Shipments ,)
<br />to U.S. Export from 4. . Port of entry/exit , tImport 1
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<br />Trans
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<br /> Date lea U.S.: porter signature (for exports only): TRANSPORTER 17. TransporterAcknowledgment of Receipt of Materials •
<br />Transporter-1 Printed/Typed Name A Signe Month Day Year
<br />A• I Pt(2,- (2.4. I I 3 134 1-Z 1
<br />Transporter 2 Printed/Typed Name Signature anti D Year l
<br />I I I _ 14-- DESIGNATED FACILITY 18. Discrepancy .
<br />/
<br />Discrepancy Indication Space Quantity U Type U Residue Partial Rejection Full Rejection
<br />Manifest Reference Number-.
<br />Alternate Faddy (or Generator) U.S. EPA ID Number
<br />Facility's Phone: I
<br />Signature of Alternate Facility (or Generator) Month Day Year
<br />I I
<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />1.
<br />Iii\
<br />2. 3. 4.
<br />20. Designated Facility er . rtification of receipt of hazardous materials covered by the manifes ace as ncted in Item 18a
<br />Printed/Typed Name S
<br />'0-All ilt-t 0 II e-)0(1 -
<br />ure
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<br />Month 1 gay .1
<br />I.U-e..A 'IlLe 1 4-1
<br />EPA Forrn 8700-22 (Rev. 12-17) Previous editions are o sol . (5ESIGNATED FACILITY TO GENERATOR
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