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=orm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> .iAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> E MANIFEST CAL000044462 209-249-3500 014374369 JJK_ <br /> _ -s Kane and Mailing Address Generator's Site Address(if different than mailing address) <br /> Manteca Bulletin 278 Button Avenue <br /> P.D.Box 1958 MSFMOM CA 95338 k <br /> Mentaaa,CA 95336 ' <br /> .•'s Phone: 209-248-35DD <br /> e.Transporter 1 Company Name U.S.EPA ID Number <br /> Califomia Environmental 8 Litho CAR000009910 OCT 2 9 2 0)j <br /> '.T ansporter 2 Company Name U.S.EPA ID Number <br /> 8.-ss--ated Facility N�yne and Site AddfEss . U.S.EPA ID Number L)r)CDA gTA4 IT`� <br /> ommo 65ourae ZS trmronmental CAD982433575 <br /> 11 B47 United street <br /> Mojave,CA 93501 <br /> Phone: 661-824-2416 <br /> oa 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> H%l and Packing Group(if any)) No. Type Quantity Wt.NoI. <br /> X 1 NA3082,Hazardous Waste.Liquid,N.O.S.,9,PGIII (Waste silver) 001 DF 55 G D011 <br /> 0 541 <br /> ar <br /> LU <br /> I L ot <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1.Weds photochemical Fbor(Silver) ERG#171 <br /> 1 <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> Generators/Offerors PrintedlTyped Name Signa ur Month Day Year <br /> 1/0 <br /> J 16.International Shipments <br /> F- ❑Import to U.S. El Export from U.S. Port of entry!exit. <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> C 17.Transporter Acknowledgment of Receipt of Materials421 1 <br /> L Trac,srpllull ped Name Signature Month Day Year <br /> Za Transporter 2 PrintedrTyped Name If Signature Month Day Year <br /> c <br /> •b.Dzcrepancy <br /> _ ar.ry Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 15 Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> Q <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> f- <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1. 2. 3. 4. <br /> 1 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item.18a <br /> PrintedTTyped Name Sigralure Month Day Year <br /> EPA Form 8700-22 Rev.3-05 Previous editions are obsolete. '°i <br /> ( ) .:��.)�°��aL{N'cO De::04'�9t)iw>i'9C�3ti:�'���� <br />