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Please print or type Form AtoDroved. OMB No. 2050-0039 GENERATOR ..., UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number C A C 0 0 2, 0 5 7 6 3 8 2. Page 1 of 1 3. Emergency Response Phone (888) 423-5051i 4. Manifest Tracking Number 021324617 JJ K Generator's Name and Mailing Address Edward Philiis Generator's Site Address (if different than mailing address) Att NSF Railw p B ay BNSF Rally-a,/ ,, ., 740 East Carneqie Drive 37.33233, -122.0312 MF1110 San Bernardino CA 02408-3571 !Stockton CA 05215 Generator's Phone: 0 n r, 2 ? E 1 0 '3 2 Transporter 1 Company tsrgme' U.S. EPA ID Number American I ntetirated Starvic.*.s, Inc. I C: A R 0 0 0 1 4 8 3 3 8 Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number Crosby a. Overton, Inc. 1830W. 17th Street Loll Beach CA 00813 rpF. A h7 n 1 7Eldnqn1 q Facility's hone: 5,5 .-, 122'.:1 _ 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit Hm and Packing Group (if any)) No. Type Quantity Wt.Nol. 13. Waste Codes Non-RCRA Hazardous Waste, Solid (Soi) /Ballast Rock and Diesel) 0 0 1 DM ___CC) F 14. Special Handling Instructions and Additional Information Alw.zvm Wear Appropri2te PPE when h2nd1ing w2te. Weightm or volume 2re approximmte. Sor_i) PrDfile Number: 115257 AIS Job Number:80010-05 SID1;8998 (720 South B Street-, Stockton, CA 95215 15. GENERATOR'S1OFFEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, aid 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 I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if lam a large quantity generator) or (b) (/fl am a small quantity generator) is true. GeneratorsiOfferor's Printed/Typed Name Signature Month Day Year JON 66/4.41r er tak c.,e4065 _CA.Alc-44 6 I ••‘,- .-..0,4,- I 4 I2 - r2-6 I- 16. International Shipments Import to U.S. Export from U.S. Port of eit6/exit: Transporter signature for exports only) Date leaving U.S.: TRANSPORTER 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature / Month Day Year /frqk 6 /114 kiXit.)6 I &le C'C' I Le. 12- f-(--1-3 ,,(1 Transporter 2 Printed/Typed yped Name Month Day Year I I I I DESIGNATED FACILITY 18. Discrepancy Discrepancy Indication Space 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) 1. 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Name Signature Month Day Year I I I .1 EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM