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Please print or type. Form Approved.OMG No.2050-0039 <br /> UNIFORM HAZARDOUS I 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number C <br /> WASTE MANIFEST CAF,00U220046 1 909-984-9984 018217523 FLE <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> CALIFORNIA FU-',ALTH C•AFh; FACILITY (07557) 7707 SOUTFI AUSTIN ROAD <br /> 7707 SOUTH AUSTIN RQAD (attn: M. wrestle STOCKTON, CA 9521.5 (attn:mark whistler) <br /> STOCIs.TON, CA .95215 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> 8.Designated Facility Name and Site Address U.S.EPA iD Number <br /> AA SYDC;UL,LLC <br /> 2264 E. 13th street <br /> 1UM_A, AZ $5365 <br /> Facility's Phone: y <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Typo <br /> Quantity Wt.Nol. 13.Waste Codes <br /> a 1' Non RCRA Hazardous waste li-quict (latex paint) 291 i <br /> t ? ✓ I1 0 <br /> w 2. Non RCRA Hazardous waste solid (oily rags) 27; <br /> c� <br /> 3. <br /> I I <br /> 4. <br /> 14.Special handling Insbuclions and Additional Information <br /> 1) Latex paint-app#x.10353-LL1 2) oily rags--app# S10384-SLI <br /> ) i>ess-7 <br /> 15. GENERATOR'SfOFFERO 'S CERTIFICATION: I hereby declare(hat the contents of this consignment are fully and accurately described above by(he proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in praper condition for transport according to applicable international and national governmental regulations If export shipment and I am the Primary <br /> Exporter,I teddy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment ofC nsen(. r , <br /> I certify that Iha waste minimixaiion statement identified in 40 CFR 262.27(a)(if l am a targe quantity generator)or(b if I am all qu�anlirylgenerator)is tree. <br /> Generalorsl0fferors Prinlecirryped Name (l! <br /> Signature Month Day Year <br /> 16.Intemalionat Shipments <br /> !- ❑Import to U.S. ❑Export from O.S. V Pad of enuyfexil: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> rr 17.Transporter Acknowledgment of Receipt of Materials <br /> ur <br /> Transporter 1 Piinte//d{{T!Typed Name M <br /> / Si al onth Day <br /> Year <br /> � ransporter 2 Prmledr[yped Name J Month Day Year <br /> r- <br /> 18.Discrepancy <br /> 16a.Discrepancy Indication Space ❑ QuantityResidue <br /> Type Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Facifity's Phone: <br /> M 16c.Signature ofAllemale Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Repan Management Method Codes(t.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. T <br /> 4. <br /> !y <br /> 20.Designated Facility Dwner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedrryptd Name Signature Month Day Year <br /> 'll,� 13 1 z4 <br /> EPA Form 8700-22(Rev.12.17) Previous editions are obsolete. +i_SIGNATED FACUTY TO EPA's e-MANIFEST SYSTEM <br />