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USC- 80578- 6-277
<br /> Please print of pe.(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.Manliest TratlOng Number
<br /> WASTEMANIFEST .-CA1A001N.W-: _ L.
<br /> , S1GIr 4747-, ..0.03615186 JJK
<br /> 5,Genaratoes Name and Mailing Address Generator's Site Address(tiddfefefd than mailing address)
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<br /> STOCKTON,CA.7y4-.
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<br /> U.S.-EPA(l)NumberTrs
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<br /> 7.Transporter 2 Company Name U.S.EPA ID Number y
<br /> 8 F U.S.EPA ID Number
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<br /> Facility's Phdne:•I
<br /> ga_ 9b.U.S.DOT Description(ncludmg Proper Shipping Nara,Hazard Gass,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes
<br /> HM and Packing Group('d any)) No. Type Cho" WL/Vd.
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<br /> 14,Special Handltn Instructions arldAdditlanel I adon
<br /> .HIAIIDLES TO BE TRAO..-SMS .-W-- iO4 R 1M. �:,
<br /> 15. GENERATOR'BIOFFEROWS CERTIFICATION.1 hereby declare that the contents of this consignment are fully and awstay described above by the proper Shipping name,and ere classified,psr#aged,
<br /> marked and labeledfplacarded,and are In all respects In propercondltlon for transport sccordbtg to applicable httemedonal and national governmental regulations.If export shipment and I am the Primary
<br /> Exporter,I tervy that the contents of this consignment conform to the terms of the attached EPAAcknowledgmeni of Consent.
<br /> I c rtiy that the waste mitimlration statement IdeWed in 40 CFR 262.27(a)(if I am a large quenh'fygenerator)cr(b)pf I am a small qu y generatar)1s bue.
<br /> Ge torslOrterorb Prim Day yew
<br /> ma Stg Sure �Month
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<br /> .'IfillematlonalShOments
<br /> ❑Import t0 U.S. ❑Export from U.S. Part of trylaxit
<br /> Transporter signature(tor eWts only): Dam I ng U.S,:
<br /> 17.Tratupww Advmowledgment o1 Receipt d Materials
<br /> Transporter 1Pdnteda ad Name ' Menth Day Year
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<br /> aTransporter 2 tedlTyped Name S' m Month Day Year
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<br /> 18.Discrepancy
<br /> 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejactian
<br /> Martifest Referersre Number.
<br /> 18b.Alternate Facility(or Generator) U.S.EPA 14 Number
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<br /> LL Fadiity's Phone:
<br /> 18c Slgnaturs of Alternate Facility(or Generator} Month Day Year
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<br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Ireatmenl,disposal,and recycling systems)
<br /> C 1. � 2. 3. 4.
<br /> 20.Dapality Owner or Operator:CeAifrc Wn of recelpt al hazardous materials covered by the exce in Item iSiN
<br /> Printedrryped Nama ignabrre M Day Year(
<br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. BMMAffiETFACILITY ATIO TATE(IF REOUIRED)
<br /> 10307.0938
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