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11,,�� Form Approved.OMB No.2050-0039 <br /> Please print or type.(Form designed for use on elite(12-pitcnTlypewdtec) <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3 rgencq Response Phone 4.Man'rfest Tracking Number �� <br /> A D 9 8 1 4 4 7 0 5 5 1 Y08-727-5504 0025112-55 <br /> '� 9 +4 Z9 <br /> WASTE MANIFEST 0 e. 1 F <br /> B4lerBU37�sN6Ms>Bd3?BEKS Geneatoes Site Address(it different than moving address) <br /> .O. BOX 1376 12101 E. BRANDT RD. <br /> CREFORD CA 95237 LOCEEFORD CA 95237 <br /> 209-727-5504 ATTN: GREG LEWIS <br /> Generalols Phone' <br /> 190 a8$VIercinmental (650)588-2838 C k FRE961VOi 5 9 4 5 9 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> �igryFaAag�§nt, Inc. U.S.EPA ID Number <br /> 5251 Old Skyline Road <br /> (800)222-2964 CAT 0 0 0 6 4 6 1 1 7 <br /> ttleman City CA 93239 <br /> Fadlity's Phone' <br /> 9a 9b.U.S.DOT Description(induding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WtNal. <br /> 1. <br /> WQ (OIL, ABSORBENT) V, p 7+ 1 <br /> K <br /> Z 2, NON RCRA HAZARDOUS WASTE SOLID <br /> (OIL, ABSORBENT) F P <br /> 7 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> ERG NRK EB8743 SEE PROFILE EB8743 / SOLID 10 <br /> ERG NRK EB8743 SEE PROFILE EB8743 / SOLID 2: <br /> 3: <br /> 4: <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this censigornent are fully and accurately described above by the proper shipping name,and are dassified,packaged, <br /> marked and Iabeledlplacarded,and am in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the tamer of the attached EPA Acknowledgment of Consent. <br /> I ceNfy,that the waste minimization statement identified in 40 CFR 26227(a)(ff I am a large quantity generator)or(b)(d I am a small quantity generator)Is We. <br /> nerratM s not yped me bignature Month Day Year <br /> 16.International Shipments <br /> F ❑Import to U.S. El Expert from U.S. Port of entrylexit: <br /> Z Trans iter signature for exports ondf) Date Waving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Tjznsporter t PhntedRyped Name Signature Month Day Year <br /> a <br /> N I. <br /> Q Transporter 2 PrimedRyped Name Signature onM ay Year <br /> K <br /> F <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ OynBry ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> N <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,cedes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certifioalion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> { Printedflyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />