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--------------------------------------------------- <br /> r <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Numberry�+l� �( <br /> WASTE MANIFEST SRI,OOCS59?J77 ;;s a.:fr;;.r�;F`:0 013435262 JJK <br /> Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> PACIFIC SOUTHWr ST IRRIGATI%) <br /> 8"x72 S.JACK T ON RD. ..� <br /> STOCKTON, A 95215 <br /> Generators Phone: :- -450-04ti' e�l, <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> r;ecfae kt. Lwro,w. EB 2 4 2015 ^: I D,tzcvl <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> ENVIONMFNTAL <br /> 8.De Gli N e ss U.S.EPA ID Number <br /> Dellp% r ' 31�,"9 J11 Rf�� HFXTH nFPAgTMFM a- <br /> 16Tr3 iq 17T"T"Street <br /> +•ONO&f,°S'.n.'ii,CA 97:1K <br /> Fadlitys Phone: '700'Fx7-6729 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> HM and Packing Gmu (itany)) No. Type Quantity WtNol. 13.Waste Codes <br /> p <br /> 1 !! 1`F„ `tUa;t'E P;AA,IIv4;A>�Jy U;a1A0 s, ;, t` .. _• 3 F's3?S ;;,.1 r . .. I Ekl?1f. <br /> 0 , f <br /> ao <br /> 2' 2 <br /> 3. <br /> 4. <br /> Special Handling Instructions and Addiganal Information l! <br /> EFCd 12A ,-%atonr PVr,pipe pdrrsa Of 9-126 !Flb'CnCEFt <br /> QGE <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accumlely described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper canditiorf0r banspo l according to applicable Intsmaltonaland national governmental regulations.If export shipment and I am Ihermary <br /> Exporter,I redly that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I rertify that the waste minimization statement Identified in 40 CFR 262.27(a)(If I am a large quantity generator)or(b)(d I am a small quantity generator)is true. <br /> GeneratoeslOffemts Pdnted/Typed Name Signature ,.' Month Day Year <br /> 1 t f !. <br /> 16.International Shipments <br /> i— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(forexports only): Dale leaving U.S.: <br /> w 17.TmnsporterAcknowledgmenl of Receipt at Materials <br /> Transporter l Pdn�t?•ppgd Name Signature Month Day Year <br /> CTransporter 2 Pdrdedrryped Name f Signature Month Day Year <br /> r>c <br /> F <br /> 4. 18.Discrepancy - <br /> 18a.Discrepancy Indication Spam ❑ Due,* ❑Type ❑Residue ❑Partal Rejection ❑Full Re <br /> on <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ra Facilitys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> .Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 Fr. 2. <br /> 20.Designated Facility Owner ar Operator.Cerlificallon of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnntedfryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />