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e.(Form designed for use on elite(12-p' writer.) Form Approved.OMB No.2050-0039 <br /> ,t HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergenq Response P 4.MerriestTracking Number <br /> ,E MANIFEST C&M262% 209-540-01111 1 003568315 JJ K <br /> arators Name and Mailing Address Generator's Site Address(it different than mailing address) <br /> Pro-AcM Norftnn Contener <br /> 4343 East Fremont St. <br /> Stockton,CA 95215 <br /> Generators Phone: 209-54&0111 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> California Errvir onmental 8 Llan CARD00009910 <br /> 7.Transporter 2 Company Nam U.S.EPA ID Number <br /> Asbury Enviromnentd Services CAD020277036 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> SiemensYkWrTeolmolo9issCap. CAD097030M <br /> 5375 S.SpylesAvenue <br /> Los Angeles,CA 90058 <br /> Fadlil esPhone: 323.277-1500 <br /> ge, go.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(rf any)) No. Type Quantity WtNol. <br /> 0 1' Non RCRAHmrdousWil solid(Westalnk) P 352 <br /> W <br /> �V V None <br /> W 2 <br /> (7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> a.Waste Ink #AP181858 ERG#171 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects In pmper 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 tens of the attached EPAAcknoWedgment of Consent. <br /> I certify that the waste minimbation tement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)o P a s uant y generator)is We. <br /> G9nemtor5-WVs van N � Signature O Day YO <br /> Of UL <br /> 16.International Shipments U 1/ <br /> F <br /> Elimportto U.S. ❑Export from U.S. Port of entry/ext <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> Of 17.TransporterAduwtNedgment of Receipt of Materials <br /> TranspP�md2wed Name Signature Month Day Year <br /> N ���YY b 06 D <br /> Z Transporter 2 PrinteNryped Name Signature Month Day Year <br /> C <br /> f <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Spam ❑ Quantity, ❑Tyye El Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> lab.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facilitys Phone: <br /> W 18c.Sgnature ofAltemate Facilily(or Cenemtor) Month Day Year <br /> Q <br /> 2 <br /> h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> 0 1. 2. 3. C <br /> 20.Designated Facility Owner or Operator.Certification of recelpt of hazallous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Mont Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />