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-` �At. rY r j I <br /> print or type.(Form designed for use on elite(12-ftewdter.) Forth Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trocklin Number <br /> WASTE MANIFEST CAD",'3727 1 8(Ar73: 304? O V 1 1091 JJK <br /> 5,Generator's Name and Melling Address Generator's Site Address(d different than mailing address) ,« <br /> S1'0CK1iNd SG4.VEhIGFR.� !Wht, <br /> 12401 NAv,,'r DRIVE: <br /> STOCKTOId,CA gi <br /> Generators Phone: 20r-450,39 do <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CHIT C"11FcaIN CcL LERVICC. IC.ADB86lf�m!b? <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Da0,0lllty NdlOp 8to S Address U.S.EPA ID Number <br /> 2(1(10 NORTH ALAfvtEUA,STREET CA70WIS382 <br /> COMPTON,CA 98222 <br /> Facili 's Phone:310.537.7100 <br /> ga. 9h.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Cedes <br /> HM and Paddng Group(Ifanyp <br /> No. Type Quantity Wt.Nol. <br /> m8, UNIM 13011 nM a t3 oai <br /> r�tr Vnn VI D <br /> WASTr 'FiMAgL� tfputp tJ�S, �uAq U <br /> Z 2. <br /> W <br /> THIS WASTE STREAM HAS BEEN QUALIFIED <br /> 3. FOR RE139LING4TREATMENT AT TI IE <br /> DeMENNO/KERDOON FACILITY IN COMPTON, <br /> CALIFORNIA.THIS FACILITY HAS THE NECESSARY <br /> a. PERIVIIIS 1U RECEIVE YOUR WAOIE STREAM AS <br /> QUALIFIED: OUR EPA NUMBER IS CAT08001335Z <br /> 14,4pOalHendlinglnatrgctlone9, AddlUonallnformaton <br /> - �,wgi7��MMMi1" 7'�/M/L/E' .�Nf/VT Mtk+� .3F?e,Up11G'�5 <br /> WEAR GLOVES .AND EYE PROTECTION 24 HOUR EME'RENCY CONTACT CHEMTREC SX"2443t70 AND CHICO ORM OIL SER\ACE <br /> 4.T 800-733.g043 <br /> 15. CENERATOR'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 proper condition for transport according to applicable International and national governmental reguladons.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the tonna of the attached EPAAcknowledgment of Consent. <br /> I certdy that the waste minimization statement Identried In 40 CFR 262.27(x)(If I am a large quantity generator)co)k I em a small quantity generator)Ie two. <br /> Generator' is Printed/Ty Name Signora Month Day Year <br /> e <br /> i � y <br /> 16.Intemetlona2 e:l p me <br /> ❑Import to U.S_. ❑Exportfrom45, `, Portofentrylexlt: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TransporterAcknowfedgmentof RecelptofM Is <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> 1 rensporter 2 Printer/typed Name ., Signature Month Day Year <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Rasldue ❑Pai Refection ❑Full Refection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL F,p q01 'M1U'- <br /> WICc.S,yn;dwn ct AlhanaeIaf Jnv for Ger.Fmtor' Manly Day Year <br /> H <br /> Q <br /> 2 <br /> 10.Hazardous Waste Report Mena ement McBiod Codes a codes for hazardous waste treatment,disposal,and recycling systems) <br /> P 8 (�-. V Y g Y I <br /> 2. 3. 4. <br /> / `i <br /> 1 20 Des nated Facility Owner or Operator:Certification of receipt of hazardous materials covered by me manifest except as noted In Item 18a 1 <br /> P yped Nema Signature / z Month Day Y <br /> EPA F m 8700-22(Rev.3-05) evious editions ire obsolete. /111S116NATED FACILITY TO GENERATOR <br />