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Form Approved.OMB No.2050.0039 <br /> Please print or We.(Form designed for use on elite(12-pitch) +riter.) 2 Page 1 of 3.Emergency Response Phone 4.Ma11 nifest Tracki11 ng Number J J K <br /> UNIFORM HA7ARDOUS 1.Generator ID Number 209.24D-3a100 0020377608 <br /> WASTEMANIFEST CALM10877 <br /> 5.Ge r' Nam <br /> n Kl�iling Address <br /> Generator's Site Address(if different than mailing address) <br /> 276 Bu ton Avenue <br /> Manteca,CA 95336 <br /> Generators Phone: 2W249-3500 <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name CAR000009910 <br /> C Norma Ernkonrt>antel 8 Litho <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name 001, CAD028277036 <br /> ASWyEnvi Mnental SiBrAc a U.S.EPA 10 Number <br /> 8.Desi Haig ed Facility Name and SiteA ul— S C� CAM7030M <br /> 55375sS.SO�Ae9AWIL11e <br /> L ArWIGS,CA 90058 <br /> Facility's Phone: 323,277,11 500 <br /> 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No Type quantity Wt.Nol. <br /> HM and Packing Group('rf any)) <br /> 1. Non RCRA Hazardous Waste,Solid(Waste I N(corrtemineted debris) CF P 352 <br /> 0 QOD None <br /> 0 <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> ER 7#1171 <br /> a.Waste d&is,plastic buckets,CCT* *1attsd with mlc #3600&03 ; <br /> per <br /> ing name,and are classified, <br /> 15. GENE that the contents ofthis,Qonsignm <br /> RATOR'SIOFFEROR'SCERTIFICATION: I herebyroeea not t on for transport according to applicable international and nationy and accurate al governmentaed above by l regulations,Ifpexport shipment and I am the Primary <br /> marked and labeled/placarded,and are in all respects proper <br /> Exporter,I certify that the contents of this consignment-confomrto 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-lam small quantity generator)is true.. Month Day Year <br /> _ 2t/ V <br /> Genera ors/Offerors Printe yp ame Signa re 10-31 w — <br /> Q� O D Export from U.S. Port of entrytexit: <br /> 16.International Shipments Import to U.S. — ——— — <br /> �— Date leaving U.S.: <br /> Transporter signature(for exports only): <br /> W 17.Transporter Acknowledgment of Receipt of Materials Signature Month Day Ye� <br /> Transp l ed Name 325-- <br /> O Month Day Year <br /> a Signature <br /> QTransporter 2Printed fI Nae (,Y �� <br /> 18.Discrepancy D Full Rejection <br /> 18a.Discrepancy Indication Space D quantity D Type <br /> Residue Partial Rejection I <br /> ❑ ❑ <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> J <br /> U <br /> ►ai <br /> Month Day Year <br /> Facility's Phone: <br /> LO dlity t 8c.Signature of Alternate Fa (or Generator) <br /> a <br /> z <br /> N 19.Hazardous ate Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems 4 <br /> 3. <br /> 0 <br /> 20.Designated Facility Owne r Operator.Certification of receipt of h rdous ateri vered by the manrfest except as noted in Item 1 Month Day Year <br /> Signature <br /> Printed/Typed Name <br /> EPA Form 8700-22(Rev. -0 ) revious editions are obsolete. DESIGNATED A ILITY TO DESTINATION STATE (F R �UIRED) <br />