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! i Please cant or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 ;Generator's !Genemtor HNEmeand S i.GeneratorlD Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number MCALODDSSW77 1 20}450-0450 013435267 JJ K s ailing AddressGenerators Site Address(if different than mailing address) FIC-SOLRFWEST IRRIGATION S.JACKTON RD. KTON,CA 95215 - -� - H Phone: 209.450-0450 6.Transporter 1 Company Name U.S.EPA ID Number Geoige W. Lamy,Inc. CARD00047019 7.Transporter 2 Company Name FEB 2 4 U.S.EPA ID Number e.Des 13I� Iss0Y&OVERTON NC ENVIKONMENTAL U.S.EPA ID Number 1610 W 17th Street HEXTH f)FP1PT! al!T ^^^^^�v^^^•^ Yr1WiVYVJ4l1� _ LONG EIFACH,CA W813 Facfittys Phone: 800-827-6729 -ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HNo. Type M and Packing Group(if any)) Quantity WINOI. X 1. UN 1133 WASTE FLAMMABLE LIQUID n. o. S. (AdheSNea) 3 PGit I pM f� G 281 WO7 (�1) W Z. C7 I 4. .Special Handling Instructions and Additional Information - ERG#128 TetrathydrolDrri &.Metnyl Ethyl Ketone PVC pipe glue USE GLOVES PROFILE# INVOICE# 037 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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the lemrs of the attached EPAAcknowiedgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratorsUfferors Pdntedrryped Name Signature Month Day Year J 16.International Shipments 7— Its— El Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter rint yped Name - Signature Month Day Year O a z Transporter 2 Print yped Name - Signature (S Q 9 Month Day Year K r— } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Que"fity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. late,Alternate Facility(or Generator) I U.S.EPA ID Number J U ra+- Faalitys Phone: w iBc.Signature ofAltemate Facility(or Generator) Month Day Year 2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 1 20 Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedRyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)