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fr•�l3:% Y11".1 �eASe print or type. (Form designed to' use�on elite (12-Dita U V -V y56 Jewriter.) 1- IA EA 3'0114 I.'%` ____ Fnrm4nn.n„o11 MAD KI onann YY"'v"`v. v,vi� ivv. LVJv-VVJa UNIFORM HAZARDOUS 1. Generator ID Number Mean t-tamors' nay me appropr+tare pilk7nl Tor ano Yoe aocepc me.wa-vu€ me generator Is snipping. Cl 3. Emefgency Response hone anifest Tracking Number '7000971157 WASTE MANIFEST 72P�agdellof ,�, F L E 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) Central Valley ftote Svgerr* 4 San Joaquin County Solid Waste Givis , PO Bax 1010 1333 East Turner Road Stocictl�n, CA 95201 Lodi, CA 95240 Generator's Phone: 6. Transporter 1 Com a U.S. EPA ID Number Clean Harbors Env Services Inc, M A 13 0 3 9 :3 2 2 2 5 0 TT spo er 2 Company Name �, U.S. EPA ID Number � Z X(t 44 8. Designated Facility Name and Site Address U.S. EPA ID Number Clean Harbors Sari{%I i%"'int�L d'C�� /'V(,10 3+rrr�+er ;act 7-7-1f7'- S. }#t�l�N✓gy Al 4v 114.4 / A)e 6,C C?/�f 5"" IV c, I> Faa i s i� once ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11, Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. 0 1 PAINT RELATED MATERIAL, 0lL -BASED PAINT] : 3, UN 4263, Pt, 11D 5i2 z 2. UJ 3. 4. 14. Special Handling Instructions and Additional Information 1. CH24062.5 ERG#128 OAtG X4513928 Fleet #a f d+ 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, Oackaged, 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. GenWar's/Offerors Printedfr ped Name ignature ont ay ear ► YUt brr� �� raw , _ � 71 , J 16.16teibational Shipments _ 1:1 Import to U.S. ❑ Export from U.S. Port of entry/exit: Z ;— Transporter signature for exports only): Date leaving U.S.: W17. Transporter Acknowledgment of Receipt of Materials it=— a Trans orter 1 PrintedlTyped Name Signature Month ay ear Z Trans er 2 P �nte ped Name Signature Month Day Year 1>r �-�r'�-- ��- I 18. Discrepancy 18a. Discrepancy Indication Space ❑ quantity ❑ Typej j ❑Residue ❑Partial Rejection El Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U LL ` Facili 's`Phone $ w 18c.Signature of Alter sate Facility (oFSe e " tor) Month _ Day Year Q�"•'ry +� ” Ate �% 6 `hex• I N19. Hazardous Waste R2pn[t Manpgement Method Codes (.e., cffdes for hazardous waste treatment, disposal, and recycling systems) 1 di 2;,- 3. 4. 20.15A griafed f=acility ; or Operator: Certificati `, 't receipt of hazardous materials covered by the ma st except as noted in Item 18a Prin d/Typed Name—x (j l s+I& ature Month Day Year EPA Form 8700-22 (Rev. 3:0) Previous editions are obsolete. _ _. _, _ ___ .._ _ _._ _ nFClrtieTFn Feru ITY Tn r:FUFRernR Mean t-tamors' nay me appropr+tare pilk7nl Tor ano Yoe aocepc me.wa-vu€ me generator Is snipping. Cl