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614f 99 4`SP <br />i r,.. ,,.a erre Ii9.nitrhl tvnewrifer l 1� r7 ��/�, i / if Form Approved. OMB No. 2050-0039 <br />rledbe <br />Print yr 1 Pe. rvnn u " -- t <br />I Generator 10 Number 2 Page 1 of 3 Fmergency Response Phone <br />4. Manifest Tracking Number <br />UNIFORM HAZARDOUS <br />004824399 <br />JJ K <br />WASTE MANIFEST <br />5. Genefalo/s Name and Mailing Address -- 900891891 ,xineratorilI r <br />mailing address) <br />PROFLEET, IK. - LODI 15453 N. THORNTON ROAD <br />9060 ELKMONT WAY LODI, CA 95242 <br />ELK GROVE, C#A 93624 <br />Generalots Phone <br />11 S. EPA ID Number <br />6 Transporter 1 C <br />U.S. EPA 10 Number <br />7. Transporter 2 Company Name <br />8, Designated Fad6ty Name and Site Address <br />21 ST CE1,(�JRY EMI <br />U,'; EPA ID Number <br />WUM DS DRIVE, EAST <br />it�fLEY, NV 89404 <br />NVD9WaQ533b <br />Fad s Phone: 7754Z *2ZW <br />r Na e, Hazard Claes. l0 Number, 10. Con / <br />�• U.S. DOT Description (inducing Props Sh ppk g <br />11. Total 12. Unit <br />13. Waste Codes <br />9a. <br />HM I and Packing Group (if any)) No. Type <br />Quantity WI.Nd. <br />1.phi <br />NorfRCRAFtazardous Vthete Solid }Oily Debris) <br />00 � <br />'^ <br />'^O <br />P <br />223 <br />2 <br />c7 <br />3. I <br />4. <br />14 Special Handling Inst uc0ons and Additional information <br />Manders to be 40hr tralned and use PPE <br />.. <br />9b1) 38618&00 ERG # 171 <br />15. GENERATOR'SIOFFEROR'8 CERTIFICATION: I hereby declare <br />that the con of this consignment are hilly and accurately described above by the proper shipping name, and are classified, packaged, <br />ma*ed and tebeledfplecarded, and are In all respects In prX <br />w condlllon for 11040d according to 9pp608151e intematIonal and national govenmmental regulations. If export sNpmeM and <br />I am due Primary <br />Exporter, I cantly, that the contents of this conslgrxnent con <br />rm to the terms of the attadxsd EPAAduwwiedgmenl of Consent. <br />I cti that thewaete minimization statement IdenbW In 4 <br />0 CFR 262.27(1) (it I am a large quantity genera If I am a ! II quantity genoretor) is true. <br />eralotsf rota/Pdnledll'yp�ed//Name <br />Si ro <br />Month Day Yeer <br />( � <br />C- ' - "— V <br />I C.l��'/"= <br />t'✓✓� <br />6 <br />6. Inlemabenel ipmentb❑ <br />lawn to U.S. <br />Export Pon from U.S. of enlryfexiL <br />Transporter signature (for exports only): <br />Date leaving U.S.: <br />oC <br />17. TrensporlerAcknoe4edgmen f Receipt of Materials <br />I <br />it 1 Printed? ams <br />Month Day Year <br />T at 2 Printedirryped Nome <br />rgna ure <br />Month Day Year <br />1 . Dian ncy <br />189. Discrepancy Indication Space 11 Quantity <br />rr rr�� <br />l—� Typo u Residue <br />❑ Partial Rojecfion <br />U Full Rejection <br />Manifest Reference Number. <br />18b. Altemate Facility (or Generator) <br />U.S. EPA 10 Number <br />..1 <br />fes. <br />seQa. <br />Facility's Phone: <br />F— <br />F1 <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />N19. <br />Hazardous Waste Report Management Method Codes (i.e., <br />s for hazardous waste treatment, disposal, and recycling systems) <br />►� <br />1. 7 <br />2. <br />3. <br />4. <br />20. Designated Facility Uvneror Operator: CedAcation of receip <br />of hazardous materials covered by the manifest except as n Item 188 <br />Pdnted/Typed N <br />Signature <br />Month �DY <br />)ay <br />EPA Form 8700.22 (Rev. 3.05) Previous editions are obsolet.' 61YMGNATED FACITY TO DESTINATION STATE (IF REQUIRED) <br />