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Please print or type.(Form designed for use on elite(1 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phc 4.ManifTracking Number WASTE MANIFEST CALM010877 20249-3500 053567630 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) MatoeB Buislin 276 Button AWWWA Manteca,CA 95330 Generator's Phone: 209-249-3500 6.Transporter 1 Company Name U.S.EPA ID Number Cdfornla Envkonmerrtd 9 Litho CAR000009910 7,Transporter 2 Company Name O U.S.EPA ID Number Ataxy Em*wvmr*W Gwvllm CADM77M 8.Designated Facility Name and Site Address U.S.EPA ID Number S B �COM. CAD00703M Los Angeles.CA 90058 Facility's Phone: M277-1500 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13-Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.N01. 1 Non RCRA He¢erdous Waste.SoM(festa 1 nk cw tenNn td debris) CF P 352 0 01 100 Nona Z 2. W 3. 4, 14.Special Handling Instructions and Additional Information a.Waste debit.pWWo bw1wts,curft mated with Wk #3+80305-03 FROM 71 ?-6((-66 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are-futly and accurately described above by the proper shipping name,and are classified,packaged, marked and labelediplacarded,and are in all?espects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the=attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 4QCFR 26217(a)(ifil aril a large quantity generator)or(b)(if]am a small quantity generator)is true. GeneraloeslOfferoes Printeciffyped Name Signature Month Day Year i Atr q t4 527777 -- J .Inemalona Shipments F ❑Import to U.S. ❑Export from U.S. Port of entrylexit: Z Transporter signature(for exports only): ----- Date leaving U.S.: IX 17.Transporter Acknowledgment of Receipt of Materials TransppWed Name Signature Month Day Year O CL Q Znsder 2 Pri e Name Si atur on D� Year fl CT�t��3� (Q� Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator). U.S.EPA ID Number J U LL Facility's Phone: Month Day Year W 18c.Signature of Altemate Facility(or Generator) Q1 Z O 19.Hazardo s Aaste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1. 2. 3. 4. i20,Designated Facility Owner or Op or.Certification of receipt of hardous mate4 mate' covered by the manifest except as noted in Ile I &Snn, �&� I �19K H: L�� Llq- PrintedfTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)