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Please print or type.(Form designed for use on elite(12-pitchy typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAXARDQUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number ? <br /> WASTE MANIFEST J tit; G . $SGB F <br /> 5.Generator's Name and M iling�d dress Generator's Site Address(if different than mailing ddress) <br /> i W1frIFoD 1=M Liz stzaet S motif=� � lrta Ski (-2f'il�(Co25 # <br /> 52Ca(7 �N�tt� �T �.'f3Mf+'�t-3'c.�.G • �i�f0 .. l�toU P� ec.�t..� �2,.nR <br /> Generator's Phone: f C 23) 2611 w 62-00l'�oN C'A �5 215 4 �3 - 1X90 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> San Joaquin F.iltet•Recycling CAL0001.02751 r <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facili�Ad�c ' U.S.EPA ID Number <br /> 14287,E. Manning; Farlier. C.A. 93648 <br /> (55 0)498-i)2 F4.) CAL 000102 7 1 I <br /> Facility's Phone: <br /> I 9a. 9b"U.S.DOT Descriptiom(induding Proper Shipping Name,Hazard Class,l0 Number, 10.Containers 11.Total 12.Unh 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol, <br /> 1. N UNRC R.,k l-ia.2'at-f$olis Wa.Stf;,- . �" 221 <br /> Liquid 7.(Used 01Mixed Oil) -bC�l TT Cy <br /> i <br /> Z 2. _ l <br /> lu <br /> (7 <br /> 4. <br /> 14 Spedal Handlin lnstructien and Additional Information <br /> y, eat �'rotMive Clotting . . mezg n:cy Res'ptx sfr <br /> C'oiitaci San Joaquin Filter Recycling <br /> (551) 458-0240 <br /> 15, GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that.the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,.packaged, <br /> marked and Iabeledfptacarded,and are in all respects in proper condition for transport according to applicable international and natonahgovemmentai 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 EPAAcknowtedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator).or(b)(if I-am a small.quanti y generator)is true. ; <br /> Generatoes/Offeror's Pr i T Name Signature > Month Day Year <br /> 00 <br /> 16.International Shipments rt from'U.S. <br /> Pon of entrylexit: <br /> E ❑Imporl to U.S. ❑ Po <br /> Transporter signature(for exports only): Date leaving U.S.: ' <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrintedlTyped Name Signature Month Day Year <br /> N � Month Day. Year <br /> Z <br /> Transporter 2 PrintediTyped Name Signature <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type. ❑Residue- ❑Partial Rejection ❑Full Rejection . <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> k Facilitys Phone: <br /> Year <br /> W 18c.Signature of Alternate Facility(or Generator} Month Day <br /> Z <br /> T) 19.Hazardous Waste Report Management Method Codes(i.e codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 <br /> H141 ' 2. <br /> 4. <br /> 20.Designated Facility Owner or Qperator.Certification of receipt of hazardous materials covered by the manifest except 9s note in Item 18 <br /> Printedfryped Nam Signature Month Da Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />