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Please Print or type.(Form designed for us@o elite(12 1idrr'typewriter.) <br /> Fenn Approved,OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1. r I Num r 2.Page 1 of 3.Emergency Response Phone 4.MandiOr.Ydc(U}qg N� Oro®� G B F <br /> WASTE MANIFEST 1 6 <br /> 5.Generators Name and MaAirg AddressTRW <br /> Generator's Site Address(if dirterent than mailing address) <br /> CENTRAL SFR*m 91C <br /> 1616lOEW©WAY <br /> STOCKTON,CA 96206 <br /> 'GBn82fOr9 <br /> 8.1ransPo 1 Company ane U.S.EPA ID Number <br /> FRBlOtAIU ENWRO�fI�NtAL SEMMES INC CAR090171017 <br /> 7.Transporter 2 Company Nana U.S.EPA ID Number <br /> 8.Designated Facility Name and She Address U.S.EPAiD Number <br /> ffV1EROREBrIOIL NJC DAMS <br /> 1,CA <br /> _ CAD962446174 <br /> Fatifl(s Phone:61479&4400 <br /> ga. tib.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, !10.CUontadmm; fQusnt*Ry <br /> 12.Unit <br /> HM andPackngGroup(nary)) TypeWI.Nd. 13.Waste Codes <br /> O1' NmrRCRAN11WOmW4deLA d(C WWr) �Ae , <br /> W <br /> 3. <br /> 4. <br /> X11.Spatial Handling Imtrucbom and Additional Information <br /> "Wil!41111rill,tobw40h9MMMda•duMpp�. <br /> ER�l 17 0 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this mnsighmm are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and IabeleNpimosid IT and ane in all respects in proper curldi icon for transport acmrd'aig to applicable International and national govemmmal <br /> Exporter,I tediy that the contents of has mnsignmeM conform to the terms of the attached FPAAcknowledgment of Consent. regulations.If export shipment and em the Primary <br /> Ice"that the waste miNin i(z�ation statement identified in 40 CFR 262.27(a)(if I am a loge quantity generator)or(b)(hl am a small Ch"Ilty generator)s true. <br /> Ge t O'IemPrin Nam <br /> rs tedlfypad�l�� Sign ahue Month4_. Da Year <br /> 18.Imamational Shipmems <br /> ❑Impart b U.S. ❑Export from U.S. Pod of a /axil: <br /> Transporter signature(for exports Doty): � <br /> W IT Transpanergdmcwadgmamd Date leaving U.S.: <br /> rt/�� Receipt Materials `t r t <br /> 14 Tmnsp? Month <br /> � �t Y. <br /> d. 1 <br /> Transporter2 PnntedRyped Name SgnaWe <br /> Month Day Year <br /> j18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Roue ❑Peru Rejection ❑FUII Rejection <br /> Mardest Rekrence �.� - <br /> 18b.Ahemale Facilly(w Geriemror) Number: .. <br /> U.S.EPA ID Numher <br /> v <br /> LL Faciiys Phone: <br /> Ow f8c.Signature,of ate'..Ytor Generat)() Month Day Year <br /> Q <br /> (7 19.Hanardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 14141 2. 3 4 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous maters covered()Al <br /> P ted?yped Naby Ue manifest except as noted in <br /> W me <br /> 11 <br /> SignaWre <br /> �4Q�F ti4 Llr <br /> ts CF'/4. QE W40- &P; Monts DaY Year <br /> t S. �^ ' 0 h <br /> EPA Form 8700.22(Rev.3-08) Previous editions are obsolete. <br />