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60218. 9986 <br /> Please print or type.(Form designed for use on elite 12-Pitch) r) Fonn Approved.OMB No.2050-0039 <br /> • UNIFORM HAZARDOUS 1.Gnermor ID Number 2.Page 1 of 3.Emergency Response Phone d.Mm TmcTrading Number <br /> WASTE MANIFEST C A C 0 0 2 6 1 5 2 1 2 1 100 321-5479 1 002141253 JJ K <br /> 5.Gererelors Name and MaaingAddress Gmembrs Site Address is clammed tlrm mmng address) <br /> DALWNDER DHOOT DALWNDER DHOOT <br /> 15600 S HARLAN RD 15688 S HARLAN RD <br /> LATHROP CA 95309 THROP CA 95330 <br /> Generators Phone: <br /> 6.Trnsporter 1 Company Name U.S.EPA ID Number <br /> Ecology Control Industries A D 9 8 2 0 3 0 1 7 3 <br /> 7.Transporter 2 Company Name U.S.EPA ID Netter <br /> Bented apt Name and Site Address U.S.EPA ID Number <br /> ogy on�ollndustries <br /> 255 Parr Boulevard <br /> Ri,chmcind CA 94901 <br /> Fad' Prwne:OiU 2;5-139;1 AD 0 0 9 4 5 6 3 9 2 <br /> ga, 9b.U.S.DOT Description Including Proper ShW%Name,Hazard Class,ID Number, 10.Canelnaa 11.Total 12,Une <br /> HM ant PaddingGralP I8aM11 No. Typo Quantity WIlWI. 73.Walla Codes <br /> on-RCRA Hazardous Wase,Solid <br /> o <br /> 12Aa ( 3 <br /> w <br /> 3 0 2 TP 01000 P <br /> z 2. <br /> W <br /> 3. <br /> 4. T-r <br /> 1A. bsbuctiotaandMditlorellnfANK <br /> QTY 2 EMPR"f STORAGE TAI91C9- TALAR #33947 a # 33993 <br /> ECI .1013 # 52'3367 <br /> WEAR PROPER PPE WHEN HANDLING- WEIGHTS AND VOLUMES ARE APP;ZCX 7NATE- <br /> 15. GENERATOR'SIOFFEROR'S CERnMATNRi:1 hae0y declare CW the contents of this consignment are 6dty anal acwa*described above by the Proper shipping name,and are classified,packaged, <br /> marked and IabekNpncarded,and are in all respects in proper coaition for bmspod according b applirade international and national gammmental regulations.If expr shipment and I am the Primary <br /> Expdter,I certify flan the conlenb of this consigrsnaN conform b the arms of the attached EPAPcknowledgmeM of Consent. <br /> I certiy that de waste minimv_atlr slemmenl identified!in 00 CFR 262 27(a)(g lama large quantity gmnala)_Lb)-(gl am a small quantity geraabr)a sue. <br /> ons PdntecITAW Name- (� Mrm—Day—Year, <br /> 16.Intarralkinad 5hitfromts, El - <br /> portb U.S. Ll S. Pcrldenby/exit <br /> Tmnsporlar signature(far exports only): Date bating US: <br /> 17.TrarsporlerAclmoMedgm rd ofRempt of Materials <br /> p� Tranypwserl-PrntakJOWe 100,:=? - - Nsloommtt--p��---- <br /> �, o <br /> Z <br /> TranspOW 2 yped Name Sollblia Month Day Year <br /> 19 <br /> ti <br /> i16.Discrepancy <br /> 18a.Discrepancy Indication Spate L1 Gmtlly ElType ❑Residue ElParti&Rejection ElFullRejection <br /> Manifest Referrer Number <br /> 186.Alternate Fttdiy tar C araycr) U,S.EPA ID Number <br /> J <br /> V <br /> u FwAtys Phone: <br /> 18c SOVIUM of All FadNy,(a Generator) Marsh Day Year <br /> T <br /> 19,Hazardous Waste Report Management Me"Codes(Le..codes for hazardous waste treatment,daposK and recycling systems) <br /> 0 1. 2. 3. d. <br /> 0lyr <br /> 20.Desgread Facility Amer a Operator:Certification of receipt ofhezaNws mammals commit by du mandest except as noted in Item 18a <br /> 1 yped Nene S axe Day Year <br /> L�fb <br /> EPA Fomn 8700-22(Rev.3-05) Previous edftns amR,solete: ESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10177.0916 <br />