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ehu.. .,, ,.-.,.,., X— A..' ..A r,,, errs Hose h —" I— . . Form &-nmued. OMB No 2050.0039 <br />EPA Form 8700-22(Re'6 - 5) Prrivioiseditions a'pobsolete. tl TRANSPORTER'S COPY <br />UNIFORM HAZARDOUS <br />1..*narator ID Number <br />2 Page 1 of <br />ency Response Phone <br />. Emrge <br />4. MantlrstTcuking Hu r <br />1 U1,7616394 J J K <br />WASTE MANIFEST <br />C- L 0 0 0 2 7 6 6 89 <br />1 <br />8M 424-M �f � <br />5. Generator's Name and Mafiirg Address Generaoft Site Address"Of different than maMng address) <br />PROFI_I. i T INC LODI PROFLEET INC <br />15483 N IHORNTON ROAD 16463 N THORNTON ROAD <br />LODI CA 96242 LODI GA 95242 <br />Generator's Phone; a tj { <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />FREMOUW ENVIRONMENTAL SERWC:E3 INC C A f7 0 0 0 1 7 1 0 1 7 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8 FacilitySite Address U.S EPA ID Number <br />Cd�lm <br />HWY 95 11Mi S ; BEAf'TY <br />BEATTY NV 6$003 <br />Fadi;, s Phone: 775 563-22D3 NV T t) 0 1 0 0 0Q <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, <br />10. Containers <br />11. Total <br />12 Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (d any)) <br />Quantity <br />WtNot. <br />1 NON-RCRA, HA AF2lk.)' US WA`378, GOLID8 tOILY 61: MS, <br />ABSORBENT) <br />0 <br />W�z <br />2. <br />a <br />3. <br />4 <br />. <br />14 SpkW 14andling Instructions and Additional information 1) US 070.25683` A - Oily D&, i1 ERGAI i <br />kI�: #r ,_ -S+ -j r; : , , , , HANDII.JW'lir 13940HR I? -A MM) ANA USK Al <br />15 GENERATOR'S/OFFEROR'S R ICATION: I hereby dedare that the contents of this consignment ams fully and accurately described above by the proper shipping name, and are classified packaged, <br />marked and Iabeledlplacarded, and are in all respects in proper condition for transport according to applicable international and national govemmental regulations. If export shipment and i am the Primary <br />Exporter. I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I cartily that the waste minimization statement identified In 40 CFR 262.27;a) (H I am a large quantity generator) or (b) (If I am a small quantity generator) Is true <br />Generatok'sWaror's Pdntedfryped Name Signature Month Day Year <br />' 0$ loci <br />16 Inlemationa Stipments <br />❑Import to U.S. ❑Export from U.S Port of entrylexit: - - — — <br />Transporter signature (Por exports only): Date leaving U.S <br />W <br />17 Transporter AdwMedgment of Re4:90 of Materials <br />�Transporter <br />Sign Month Day Year <br />1 Pmud7yped Name <br />61. <br />F <br />N <br />7ransporter 2 Fdnted yped !wane Slgnatu Month Day Year <br />IB Discrepancy <br />Ias. Discrepancy Indication Space ❑ Quantity []Type Residue ❑ Partial Reecilon ❑ Full Rejection <br />Manifest Reference NuRbcr. <br />18b AMemata Facility (or Generator) US EPA ID Number <br />C3 <br />u. <br />FadEitys Phone - <br />18c �Watureci Akerrate Fadity(or eraW <br />Month Day Year <br />Q <br />Z <br />— <br />� <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposai, and racyclhg systems; <br />C <br />1 .� 2. 3 -� <br />20 FacJity Owner or Operator. Certification of receipt of hazardous materials covered by the manifest ex -::3 ,,r. rA(ed In Item 182 <br />Name ignattare i �Ic+aC y <br />Year <br />;; �: <br />EPA Form 8700-22(Re'6 - 5) Prrivioiseditions a'pobsolete. tl TRANSPORTER'S COPY <br />