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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST f. /f,E C3 Q fJ'�S `� �{d�}J 4^ -�1 00 013"'06096 JJK <br /> 5.G eralo te�tam .and Ma�li{� ddre Generators Site Address(if different Than mailing address) <br /> ��'s` 91 0�.psi!lira <br /> TRACY CA 95304 <br /> Generators Phone: <br /> 2(All <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 1,01 <br /> ;_000 td.ALAN01bit STELE-1 <br /> 001,APTON 90222 <br /> Facility's Phone: (310)537-7100 GAT 0 R O O 1 3 3 5 2 <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)) 13.Waste Codes <br /> No. 'type Quantity wt./Vol. <br /> . 0 ,',";t L ,w D00100111 3.(43o <br /> w <br /> W <br /> 2. <br /> R E <br /> FEB 2 7 2018 <br /> 3. <br /> ENVIRONMENTAL, HEALT -,--- <br /> r <br /> 4. <br /> i <br /> I <br /> 14.Special Handling Instructions and Additional Information <br /> EIAERGENITY CONTACT:CHEDf REG 2A00-424 9200 UERc6 CIS :1'29 5 PR OFILE 0 OR,I: 37 00 GASOL(NIE t. <br /> PO 0 A1110i9la099;r APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT l - <br /> 15. GENERATOR'S,'OFFEROR'S CERTIFICATION: I hereby declare(hal the contents of this consignment are fully and accurately described above by the proper shipping name,arca are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmenta!regulations.If export shipment and I am the Primary <br /> Exporter,I certify that(he contents of this consignment conform to the terms of the attached EPAAcknovrledgmenl of torment. <br /> I cedily that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a large quantity genen orator)or(bJ;(if I am a small gganlity J11 113 is true. <br /> Goner loes/O(ferorsPrinledrTypedtSanjg (Signalure�� 1 I / Month Day Year <br /> (an <br /> -_r 16.International Shipments I <br /> f 1:1Import to U.S. ❑Export from U.S. - Port of entry/exit: <br /> K Transporter signature(for exports only): Date leaving U.S.: j <br /> LW 17.TransporlerAcknowledgmenl of Receipt of Materials "--� <br /> w <br /> Transp,er 1 PrriinledlTyRed Name-f / / Signature Month Day Year <br /> oT <br /> za Transporter 2 Prinled/Typed Name 4•Knature Month Day Year <br /> f- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quvti <br /> ty 0 Type El Residue Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: t <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day' Year <br /> a <br /> z <br /> 1 <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 1-7r 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name / Signature Month Day Year <br /> I;CSG r� X � 2� �a <br /> EPA Form 8700-22(Rev.3-05)..!Ievious editions are obsolete. DESIGNATED FACT TY�-ddENERATOR STATE(IF REQUIR9D) <br />