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'v i .� •_ v.) rr'v. vii- i <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genemror ID Number 2.Page 1 0l 3.Emergency Response Phone 4.Manifest 7raokNumber <br /> WASTE MANIFEST 0 0 0 2 3 4 9 9 2 1 800 458-3038 007133193 FLE <br /> 5.Generators Name and Mailing Address Att STEVE WOODS Generators Site Address(it different than mailing address) <br /> J.R. SIMPLOT COMPANY J.R.SIMPLOT COMPANY <br /> 4803 CARPENTER RD 7707 S.JACK TONE RD <br /> STOCKTON CA 95215 STOCKTON CA 95215 <br /> Generators Phone: o - <br /> 6. ransporterl mpanyNme U.S.EPAIDNumber <br /> MP Environmental Services C A T 0 0 0 6 2 4 2 4 7 <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 /> WASTE MANAGEMENT,INC-KETTLEMAN HILLS <br /> 35251 SKYLINE ROAD <br /> KETTLEMAN CITY CA 93239 <br /> Fadli s Phone: en 00 g2pQ 1 (7- <br /> 9a 9b.U.S.00T Descni(including Proper Shipping Name,Hi Class,10 Number, 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group It ai No. Type Quantity Wt.Nol. <br /> 0 NON RCPA HAZARDOUS WS4STE uD(jP.ENCH SLUDGE) fs11 <br /> OO/p DM Z7 O P <br /> W 2 <br /> l•J <br /> 3. <br /> --T4. <br /> 14 Special Handling Instructions and Additional Information ')TRENCH SLUDGE,PROFILE#CA010544. WEAR PROPER PPE. <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION: I hereby declare that the contents of this consignment am fully and acmrmly described shove by the proper shipping name,and are classified,packaged, <br /> marked and labeleciplacarded,and are in all respects in proper condition for transport according to applicable international and national gevemmenfal regulati ns.If export shipment and l am the Primary <br /> Exporter,I certfy that the contents of this consignment conform the tens of the attached EPA Acknowledgment M en. <br /> I ceri that the waste minimization statement idemifi din 40 R26227(a)(itlamalarge quanety generetoQ or )(cite small quantity nerator e. <br /> Generators/011maorsf,dposdi Name Month as <br /> 16.International Shipments <br /> F ❑Import to U.S. Expod U.S. Part of enay/exit: <br /> z Transporter signature for exports only) Date leevin U.S.: <br /> W 17,Transporter Acknowledgment of Recut of Materials <br /> oTransport I PpnlgdRyped Nam / i9nature o� ay ear <br /> d 6✓/J�.t4 .vee/} N. ) (pi <br /> mIramporter 2 Pante0fryped Name ignature Morin uay Tear <br /> C <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity Type ❑Residue ❑Partial Rejection ❑Full Reaction <br /> ffWLfVyA-W O.S cksoltlr r1wd ` id asrika �e-'ti 4M (+AW W <br /> LQ ifesl elerence Number D404 /-6 WGr rf <br /> 18D.Aremate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> Q <br /> LL FadN sPhone: <br /> w 18c.Signature ofAltemate Fadlity(or Generator) Month Day Year <br /> Q <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hmrdous wastereaunent,disposal.and recycling systems) - <br /> C 1. 2. 3. 4. <br /> 1 20 Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted In Item l8a <br /> PrimetlRyped Name Signature Month Day Year <br /> ►� . Ceruev► 42 (Y 03 IV; <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 12291.1016 <br />