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03-04-'15 15:50 FROM oles Environmental 661-322-880 T-454 P0005/0012 F-856 <br /> Please print or type.(Form des(ned for use on elite(12-01 ch)typewriter.) FolmAppfoved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Pagotof S,Emergency Response Phohc 4.Manifest'Racking Number <br /> WASTE MANIFEST ' CA LrADSS8M i 2X)9.466.0460 013435261 JJ K <br /> S.Generslofe Name and Mailing Address Generators Sle Address(it different then mailing address) <br /> PACIFIC SOUTI-MICST IRRIGATION <br /> SB72 S-JACKTON RD. <br /> STOCKTON,CA 2=5 <br /> Generamis Phone: <br /> 6.Tragspoder l ComNsme y O.S-EPAID Number <br /> Compaq <br /> George W.Lowly,Inc. @ CAF7.00047019 <br /> 7.Tmnspader2 Company Name APR OS 2015 U.S.EPAONumhsr <br /> 8.0 a rip N E8 ASit rens U.E.EPAIDNumber ' <br /> 1610 dvreet ENVIRONMENTAL <br /> t610W171h street Itcr�r Tr�,..t•p�r>r�scglT <br /> LONG BEACH,CA 2MIS <br /> FauliysPhone: BOD-5275729 <br /> gg 91a.U.S.DDT Descdpgm((nduding Proper Shfiming Name,Hoard Class,ID Number. %Canlainam 11,TOW 12,Unit 13.Waste Codes <br /> HM and Pacing Gmup@!any)) No. Type Quantity Wtivai. <br /> X 1' LIN 1133 WASTE FLAMMABLE[!QUID n. D.s, frWhesh eels P011 DM 17001 <br /> z 2. <br /> w <br /> r <br /> s. <br /> 4. <br /> 1 14.Special Handing Instructions endAddiOanal Information <br /> \- ERG#128 TelrahydroNrh&MBthyl ethyl Ketone PVC pipe gide <br /> USE GLOVES PROFILE6 q4 <br /> 5, INVOICL'# AS-0,36 <br /> 16. GENERATOR'SfOFPEROR'S GER'RFICATIDN:Iharetrydeclare Nstlhe mnlenk aflhis consignmentam iultyand axurafeydescribed above by Dm pmparahipping name,aN eredd>sifiad,packaged, <br /> mated andlabele4facar4cd,Und are In all respeetsin propercondgon for tmnspohacroang Ioapplicablo inmma0onalend national governments]regulations.lf expoAddpmsnl and I emthe;Psimary <br /> ElpoAeGlufJfy tial thecon(enfeorlhle mnsignment eanlo7m WNe terms ofNealleched FPAArAnovAedgmenlafCansent. <br /> I codify that the waste mildmizallonstattement IdenOfied in 40 CFR 26nlr(e)(dt am o targe quard ygenerator)or (dl am a small quantiygenemlor)Is Ws. <br /> GanerdotsfoBarors PAniedny ed Name Signature .. Month Day ear . <br /> 6' i 1 a I Rf I (5 <br /> --oiB.InlsmatiowlSNpmams ❑Expod from U.S. Pod ofcn uwl: <br /> W El Import b U.S. 5Yp <br /> Transponersignaltue(forexpodAonly): DateteaviRq U.S.: <br /> 17.VanspoderAdmowledgmenlofRaeeiptof Materials <br /> Transportori le Pod Signature Mont Day Year <br /> Transpodsr2 PdhWnWed Name Signature Month Day Year <br /> f- <br /> 18.Discrepancy <br /> too.Dismapancy Indication Spars ❑ Quantdy ❑Type 1:1 Residue ❑Pediel ReductionJ <br /> Fug Re action <br /> Manifest Reference Number. <br /> 181b.Alternate Fadi lot Gcncmtor) U,S.EPAID Number <br /> r5 <br /> Faci Ws Phone: <br /> 18c.Signalure of Alternate Fealty(or Ganeator) MaslA Day ear <br /> ( 19.Hazardous West&Report Management Method Codes;(1,9„codes for hazardous waste treatment disposal,and recycling systems) <br /> 2. 8. 4. <br /> 20.Desiwaled Fadidy Crrneror Operator.Codification ofremryl•(hazardous materials covemdbyao mariffestextAlas noted in Item 18a <br /> PMIedRyped Nemo S nal re Month Day Year <br /> O <br /> I <br /> EPAForm 0-22(Rev.3-05) Previous editions ateobsolele. DESIGNATED FACILITY TO DE TINATION STATE(IF REQUIRED) <br />