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Form Aooronred. OMB No. 2050-0039 <br />vie <br />print or type. (roan oesigueu mr use ors ami t Fav mu %v^ 11— 1- <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />2. Page 1 of <br />1 <br />3. Emergency ftes rise Phone <br />bee -7e -722s <br />- <br />4. Manifest 1004901479 ggF L E <br />WASTE MANIFEST CaLOD0194471 <br />5. <br />Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />Central Valley Waste Services Ina <br />1333 Z Turner Rd. <br />Lodi, Ca. 95240 <br />GenemtoesPhone: 209 333-5611 <br />0.5. EPA ID No <br />ransporter I Company Name <br />�6=007054D <br />Advanced Chemical Transport <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />6. Designated Fadliry Norma and Site Address U.S. EPA ID Number <br />Chemical Wait! Mana9ONOnt <br />35251 Old Skyline Road <br />Eettlesan City/ G 93239 64000646117 <br />Facility's Phone: 559-3 i-9711 <br />9a, <br />91b. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11, Total <br />12. Unit <br />13 Waste Codes <br />No. <br />Type <br />HM <br />and Pacing Group(dany)) <br />Quantity <br />WVvol. <br />91 <br />K <br />1, Won RCpA Hazardous Waste, Solid (024Y 110.1,31,0601yy. <br />�'', <br />�"` <br />I <br />(Pilo <br />p <br />0 <br />z <br />z. <br />w <br />U' <br />3. <br />4. <br />14. Special Handling lnsaudions and Addronal Inootion �/ l <br />0600162; CZC-0C)POD�I L-{ l Ird T J <br />1) <br />project WgsLer: CV02824-03 <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby cedar Nat the contents of this canregnment are fully and accurately described above by the proper shipping time. and ars claseled, packaged, <br />marked and Iabeleelplacarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. 0export shipment and I am the Primary <br />Evpoder, I ar ify that the intents of this miisigrm am conform to the terms ofthe attached EPAAdmowledgmenl of Consent <br />I certify that the waste minimisation statement identified in 40 CFR 262.27(a) (d I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />sato Offemes Pnnti Name gn n y yw <br />o 1010 <br />em-- <br />J <br />16. International Shipments ❑ Impod tp U.S. ❑ Evodtrom U.S. Port of enaylexit <br />i <br />Date leavin US.: <br />Transactor sinature for exports only): <br />W <br />17. TransponxA.ciewwaidgment of Receipt of Materials Month ay Y081 <br />f <br />a, <br />a <br />goal <br />7r 1 �p�e//dName /�r'^ <br />I^ y' Z ►o ole II <br />�Y <br />y <br />{Q• Y f3igilaturo onth Uay Year <br />ransporter 2 PnnledlTypW Name <br />C <br />r <br />till. <br />Discrepancy <br />iia. Discrepancy Indication Space ElQuantity ❑ TYpe ❑ Residue ❑ Partsl Rejec6an ❑Full Rejection <br />Manifest Reference Number: <br />16b. Alternate Facility (or Generator) U.S. EPA IO Number <br />J <br />U <br />LL <br />Phone. <br />Facili 'M <br />w <br />18c. 5ignaWre of Alternate Facility (or Generator) Monty Day Year <br />Q <br />y19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and meyding systema) <br />Q <br />1 2 3. 4. <br />20. Des adlity Owner ar. tor. Cerbfmkm of receipt of haurdws materials covered by the sept as noted in Item 16a <br />Ye� <br />1 <br />1D <br />PrintedlY N r Mi <br />E IF REQUIRED} <br />EPA Form 0700-2(Rev g5) Previousedi6onsareobsalete. DESIGNATED FACILITY TO DESTINATION STAT <br />