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Please print or type- Form Approved.OMB No.2050•DO39 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Emergency Response Phone 4.Manifest Tracking Humber <br /> WASTE MANIFEST A (��. $+� 1 4� 367801613 <br /> 305 F L E <br /> 5,Generalors Name and Mailing Address Generatars Site Address(if different than mailing address) <br /> METAL FINISHING SOLUTIONS-STOCKTON METAL FINISHING SOLUTION& <br /> 1 A25 El.PINAL DRIVE 13TS EI.PINAL❑RIVE <br /> STOCKTON CA 95M5 STOCKTON CA 952DS <br /> Generator's Phone: 4N$8N-8t,2 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ALL CLEAN HAZARDOUS WASTE REMOVAL,INC. C A D B 0 8 4 9 2 3 9 9 <br /> 7.Transporter 2 Company Narne U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> US ECOL,OGYNEVADA <br /> HWY95 111 MILES SOUTH OF BEATTYBEAM NV &9M <br /> Facility's Phone: 0 7!053r-Z,403 N V T 3 3 0 01 0 0 0 0 <br /> 9a. 9b.U-S-DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers ii.Total 12.Unit 13.Waste Codes <br /> HM and F3ckN Group(if any)) No. Type--] Quantity WI(Vol. <br /> c i Rill,LIN$265, WASTE CORROSIVE UnUlpfi, BASIC. INORGANIC, TP 121 <br /> r <br /> N.O.S., 9, FG-11 (s 0IUM HYDR(MDe,.ALUMIi1NUM) <br /> z 2. <br /> LU <br /> 3. <br /> 4. <br /> 14.Specal Handling Instructions and Addltional Information W LTO ALL CI,@M PCW 2fi= ,ep 9b1JGMi37Vf0N0-SPENTCAUSTIC CLEANER RANK 2) <br /> Jr -29>C J/ <br /> -ACIfW43*239289 r2d322-C6 <br /> 15- GENERATOR'SIOFFEROR'S CERTIFICATION.I hereby declare that the oonlents of ftws consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper con6lion for transport acoording to applicable Intemationaland national govemmenlal regulations.ff export shipment and I am the Primary <br /> Exporter.I certify that the contents of this consignment oonhxm to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste mfrdmlzalion 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. <br /> Generator' es Printedrryped Na m¢ Signet Month nay Year <br /> S �f J]1 • j <br /> �" - M- <br /> 16.InIemalional Shipments Y <br /> F ❑Import to U.S- ❑Expnn from U.S. Port of entrylexib <br /> z Transporter signature(for exports only): DaW leaving U.S--: <br /> Ed 17.Transporter Acknowledgment of Receipt of Matedas <br /> Uj <br /> Transporter 1 Prinledlfyped N Signature Month y Year <br /> 7ranspq(ter2 PnnladrTyped Name f Sfgnalure Month {lay Year <br /> f- <br /> 18.Discrepancy <br /> 153.Discrepancy Indkatbn Space ❑ CglBntit <br /> ! ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> L� 1`8dtlly's Phone: <br /> 18c.Signature ofAllernale Facility(or Generator) Month pay Year <br /> N19.Hazardaus Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU i- 2. 3. 4. <br /> 20.Designated Facility Cramer or Opefabr..Certificalion of receipt of hazardous materials covered by the manifest except as noted in item 1i8a <br /> Prince yped Name Signa IT <br /> EPA Form 7W-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's a-MANIFEST SYSTEM <br />