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Please print or type. Form Anoroved. OMB No. 2050-0039 re o ...,,,- o2 Li, Z tiii 0 UNIFORM HAZARDOUS WASTE MANIFEST 1 t . Generator ID Number b A C 0 0 3 0 5 7 6 3 8 2. Page 1 of 1 3. Emergency Response Phone (888) 423-e0bri .. 4. Manifest Tracking Number 0 21 3 2 4 6 1 7 JJK Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Att Edward Phillips BN SF Railway BNSF RallYay 740 East Carneoie Drive 37.33233, -122.0312 10°1119 .an Bernardino CA 92408-3571 'Stockton CA 95215 Generator's Phone: 0 0 rl 2 9 e 1 0 9 '2 Transporter 1 ComparTy Warne- U.S. EPA ID Number American I nteorated Services, Inc. I C A R 0 0 0 1 4 8 3 3 8 Transporter 2 Company Name U.S. EPA ID Number IL' ' ViirC--- \ \ AAA)r \ 1A/ \ e..k.-W , -l9 J/t/ tc-A-A I OP-ii----cy»teeboq7 Designated Facility Name and Site Address U.S. EPA ID Number Crosby 8, Overton, (no. 1820 W. 17th Street Long Beach CA 90813 Facility's Phone: 5F..2 4 .32 IcAnn --28d n q n 1 A .1115. ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit Waste Codes 13. H HM and Packing Group (if any)) No. Type Quantity Wt.Nol. Non-RCRA Hazardous Waste, Solid (Soil /Ballast Rock and Diesel) -,F,-., 0 0 1 DM '212.0 P 14. Special Handling Instructions and Additional Information Ali'ruym Wm.:a r Apr: rop 1.7 iz,te PPE wheri hzndling T../t..,-be .. Weigh-be or volume ;Are :-.).F..pr ox int .-t.e _ 9b.1) Profile Number: 115257 AIS Job Number:80010-06 SID48998 (720 South B Street) Stoc.kton, CA 95215 i'24,s2-cr -P‹ 5S- 15. GENERATOR'SIOFFEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard are classified, packaged, 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 lam the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if lam a large quantity generator) or (b) (if I am a small quantity generator) is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year e5A) i; 04.kt r er ow Ci! Rcoi5;1 A ic- 44 ce I .,(e.-- _CAW-7- I II r2- r2-6 _., r---. ..?_ 16. International Shipments Liii Import to U.S. Export from U.S. Port of ent6,/exit: Transporter signature (for exports only): Date leaving U.S.: E5 17. Transporter Acknowledgment of Receipt of Materials TRANSPORTE Transporter 1 Printed/Typed Name Signature Month Day Year 414111(' 6 AA ria-We: -i, I ,r, . . • / 1 4 I2. fcizi TramPrintedlTred Name ) 1..e.A..„‘s„..._ Signature Month Day Year a- 4- DESIGNATED FACILITY --0. 18. Discrepancy Discrepancy Indication Space LIII Quantity Type Residue Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) ,. 4.,)• 1 2. 3. 4. 20. De nated Facility Owner or Operator: Certification of eceipt of hazardous materials covered by the manifest except as nded in I eni 8a Printed/Typed N me A Signature Morith Dr 0.1\---7. .. I Il EPA Form 8700-22 Rev. 12-17) Previous editions are bsolUte. E9IGNATED FACILITY TO EPA's e-MA