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I 1 print or type.(Form designed for use on elite(12-pitch)typewdlec) Form Approved.OMB No.2050-0039 I INIFORM HAZARDOUS 1.GenemloriO Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number l WMLMANIFEST CALOOD35OTr 1 209-460-0450 013435269 JJ K Pqws Name and Mailing Address Geneator's Site Address(if ciifferent than mailing address) �! .11FIC SOUfHiMEST IRRIGATION 8372 S.JAC19ON RD. STOCKTON,CA 95215 Ij enealofs Phone: 209-460.0450 Transporter 1 Company Name PA ID Number i George W.Lowry,(no. HECENt ' CARODO047019 Tmnsporter2 Company Name U.S.EPA ID Number APR 08 2015 Desi paled Fanlittyy Name and Site Address U.S.EPAIDNumher I' 1620E E. 13RULD AGEL TRANSFER INC. ENVIRONMENTAL !I 1620 E. BRUND BAKERSFIELD,CA 93307 HEATH nF:PGPTAAChIT (` ii cillys Phone: 661-.°22-8256 . I! r. 91h.U.S.DOT Description(including ProperShipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Wasle Codes Ii M and Packing Group('d any)) No. Type Quantity WWol. I: t' NON RCRA HAZARDOUS WASTE SOUD (metal grindings) DM P $52 2. i! i. 3. 4 I� { V'Wndlhng Insbuctions and Additional information -03—01.? 015 Iy u crW*171 t FUSE GLOVES INVOICE# 2-S037 1 GENERATOR'SIOFFEROWS 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, marked and lahetedliplacarded,and are in all respects in proper condition for transport according to applicable lntematianaland nalional governmental regulations.If export shipment and l am the Primary l Exporter,Icer ily that the contents of this consignment confann to the len of the attached EPAAcknowledgmenl of Consent. [y I witty that the waste minimization statement identified in 40 CFR 282.27(a)(til am a large quantity generator)or(b)(if I am a small quanfity generator)is hue. ieratofsl0gerors PrinteLdfiryped Name Signature Month Day Year s a ' s International Shipments ❑Import to U.S. ❑Export born U.S. Pod afen0y/edl insportersignature(for exports only): Date leaving U.S.: ! Transporter AcknwAedgment of Receipt of Materials nsporterl yleff, edN a Signature Month Day Year liA 1nsponer 2 Pdnledffyped Name Signalure Month Day Year i 1 Discrepancy 1 Discrepancy Indication Space ❑ QuanOty El Type ❑Residue ❑PaNal Rejection Full ReIec8on I i Manifest Reference Number. Alternate Facility(or Generator) U.S.EPA ID Number tity+s Phone: 1 Signature ofAltemate Facility(or Generator) Month Day Year i 1, Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. " I i )esignated Facility Owner or Operator.Cer0cagon of receipt of hazardous materials covered by the manifest except as noted in Item 18a edrryped Name Signature - Month Day Year i I 18700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)