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Form Approved.OMB No.2050-0039 <br /> Please prim or type. Phone 4.ManitestTracking Number <br /> 1.Generator ID Number 2.Page 1 of 3-Emergency Response <br /> UNIFORM HAZARDOUS 801245-9518021855761 JJ K <br /> WASTE MANIFEST i= p- L C 0 C 2 6 3 7 9 d <br /> Generafa s Site Address(1 different than mailing address) <br /> 5.G {p 5"MM4ARLEY COOLING TOV ERS <br /> 200 NORTH VJQNERAVE. <br /> STOCKTON CA 95215 <br /> Generator's Phone: 2 '0 9 4 6 5 3 4 5 1 <br /> U.S.EPA 10 Number C <br /> 6.Transporter 1 Company Name VJ <br /> ° Z <br /> Number <br /> 7,Transporter 2 Company Name <br /> U.S.EPA 10 Number <br /> e.D�� t MIIXGEMENT-KETTLEMAN HI <br /> 35251 SKYLINE ROAD <br /> KETTLEMAN CITY CA 93239 r A T 0 0 0 6 4 0 1 1 7 <br /> Faclity'sPhone: 65Q 385-;200 <br /> 9b.U.S.DOT Descriptien(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,U7, 13.Waste Codes <br /> 9a. and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> HM <br /> O <br /> � SU�A"1GE 1 �1.1fl� 2,1.0.5• ���ni1L•}��( � 1 �� � , <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Addlional Imormauun <br /> 1- Wear Appropriate PPE when Handling Profile # CA615485 <br /> Filter Cake =antaining chrome <br /> (40 <br /> 15. GENERAT IOFFEROR'S CERTIFICATION:i hereby declare Thar the contents of this consignmentare fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects h propercondition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the allached EPAAcknaikdgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(N I am a large quan6tygew rator)or(b)(1I am a small quanfity generator)is true. <br /> Signature Month Day Year <br /> eratoes1D0erods PriltediTyped Name • /7 ZZ <br /> 14VIr �n SPX c*, • G <br /> 16.Inle stone Shipments <br /> Import to U.S. ❑Export from U.S. Port of entryfexit <br /> F <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> � 17.Transporter Acknowledgment of Receipt of Materials <br /> T ter 1 Pnntedlr d Na Signatu Madh Year <br /> O I <br /> EL Month Day YM <br /> zTransporter Pnnteryped Name Sgnalure <br /> Q <br /> f.. <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Allemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phor e: <br /> w I8c.Signature of Aftemate facility(or Generator) Month Day Year <br /> 4 <br /> Z <br /> LD <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> u1 1 2. 3. 4' <br /> 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Manch Day Year <br /> PrintedlTyped Name Signature <br /> \4"tI YdA -- o� Zz <br /> EPA Form 8700.22(Rev.12-17) revious editions are olete. D IGNATED ACILITY TO EPA's 9-MANIFEST SYSTEM <br />