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State of California—Environmental Protection Agency <br />Form Approved.OMB NA. 2050-0039 (Expires 9-30-99) See Instructions on back ofpage <br />Please print or, e. F6rm Department of Toxic Substances Control <br />p (yp designed for use on elite (12 -Pilch) typewriter. <br />DO NOT WRITE BELOW THIS LINE. <br />8022A (1/99) Yellow: GENERATOR RETAINS <br />8700-22 <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />aacramenro, t-amorma <br />Information in the shaded areas <br />WASTE MANIFESTC <br />R <br />is not required by Federal law. <br />12111113.1010101BS 11 3.1 2 01 6 <br />of <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />S" JarL�ux�l C/aFiAF'1'Y' <br />1810 HAZLlS'T0N <br />24411206g <br />j <br />5'iSbC3(TO19 r CA 95201, l�?^]'@i ; ,Ala son HUDSON <br />B. State Generator's ID <br />t <br />4. Generator's Phone(rL109) 4)68-3066 (�(f j ... (��6 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C State Transporter's ID [Reserved.] <br />T4ir1ti L.L.C.D. <br />AlRI D 10 16191714 18111912 <br />Transporter's Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.) <br />F. Transporter's Phone <br />r <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />Ban JoacTaitn PHHWrr <br />7880 6. TA -A. 19ridg0iford <br />H. Facility's Phone <br />Stockton, CA 95206 <br />1131 &1 HI ILI 11 ILI O <br />(209)469-567o <br />1 1. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />- <br />No. <br />Type <br />Quantity <br />Wt/VolI. <br />Waste Number - <br />a. r « r e r i7014776) <br />State <br />6q12 rg <br />E010,/ <br />D+ <br />{� <br />ss <br />EPA/Other <br />!�/R <br />N <br />6 <br />iI, ( 744778) <br />State 612E <br />R <br />010ll / <br />C) C <br />3 <br />B <br />EPA/Other K/$ <br />A <br />T <br />�I Tf 1JStY . W mon a r: <br />State <br />O <br />marntl"'nrtnesA aLiticsl(pC: 7493871 <br />1612. <br />NiR <br />REPA/Other <br />G' Gt <br />D <br />t�- rJ C' <br />P <br />d'�� <br />i59lri'A, Q, lra 0:tfr, h41 Y?, <@'iC.ad 13ett8r.18aQ) r (pt: <br />State <br />612 <br />42474&1 <br />EPA/Other' <br />D F <br />„sy ( /_ <br />J. ,Pdi'lienal f4#7*#ns fpr�Mgerials Y" 04-4118, 7447751 11CT <br />: ! <br />K. Handling Codes for Wastes Listed Above <br />74435;( .$) 1 ## 11th 62674fl ( x .� ) +� <br />a. b. <br />c <br />d <br />15 Special Handling Instructions and Additional Information <br />Waste is RCRiA exec per 40 crR 261.4(b) (1) exc3 uslam. Hear: proper PPSS gtkse&L Psand1ing hazardous <br />materials. Rite:5249 R. Tracy 61.va, Tracy Ext 91i37.6( Job 0 1463--06700 / 314 Sdulde 133 r 3.43 , 172 , 154 <br />LFseacz9eney contact., INtt0 I= (000)538-3053 WAR PROP15Ih PWK%C'.T'IVT 1QTiIP1NVr (PFE)WfMK HAMT�XV0 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />If I am a large quantity generator, I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical)y <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />OR, if I I have faith to best <br />and the environment; am a small quantity generator, made a good effort minimize my waste generation and select the waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Nam-mbesoo7vto D <br />Signature t - <br />Month Day Year <br />-AQsi9e-fs o theme ( <br />1014 O 0 <br />TR <br />17. Transporter 1 Acknowled em nt of Receipt of Materials <br />pPrinted <br />Typed Name <br />Signature <br />nt ay ear <br />8 <br />18. Transporter 2 Acknowledgement of Receipt of Materials f <br />T <br />Printed/Typed Name Signature Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />-T <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />8022A (1/99) Yellow: GENERATOR RETAINS <br />8700-22 <br />