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ype.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> ,1M HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> ,STE MANIFEST GAL000044462 209-249-3504 1 014374369 JJK. <br /> venerator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Mardeoa Bulletin 278 Button Avenue <br /> P.f9.Box 1858 Mfinl f h.DA 95338 <br /> Manteca,CA 95338 <br /> Generators Phone: 2DEt-2413-3130D <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> California Environmental 8 Litho CAR000009910 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> ENVIRONME <br /> 8.leeled Faci��,IIyy Ni�nne and Site A d ss U.S.EPA ID Number NTA <br /> L. <br /> 4DmmD0liyKssoun;61 r imnmentalr IGAITU nrDAD APAIT <br /> 11847 United Street GAD982433575 <br /> Mojave,CA 93501 <br /> Facility's Phone: 661-824-2416 <br /> ga 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group Cif any)) No. Type Quantity Wt./Vol. <br /> X 1 NA3082,Hazardous Waste,Liquid,N.O.S.,9,PGIII(Waste silver) 001 DF 55 G D011 <br /> 541 <br /> UJ 2 /2rP,0 NO 5�1 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1.Waste photochamjjicall Fixer(Silver) _ ERG*171 <br /> Z ` ��' ISID l�(Q�1/Cc�� C&Za91Jp7 <br /> 15. GEN ERATOR'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 labelediplacarded,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 PrintedrTypeName /< Signatoa�-, <br /> Mon Day /Year <br /> Ire 2 v 3 Z I 0 /s <br /> -J 16.International Shipments <br /> ❑Import to U.S. El Export from U S. Pod of entry/exit: <br /> z Transporter signature(fo,exports only). Date leaving U.S.: <br /> C 17,Transporter Acknowledgment of Receipt of Materials <br /> TranspFr�%SWOWed Name Signature Month Day Year <br /> rx: arc (2,u- 101 3 /r <br /> Transporter 2 Printed/Typed Name Signature Month Day Year <br /> Q <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> H 1 Bb.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c,Signature of Alternate Facility(or Generator) Month Day Year <br /> r— <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � <br /> 1. 2. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as ncled in Item 18a <br /> Printedrryped Name Signature Month Day Year <br /> EPA For 8700-22(Rev.3-05) Previous editions are obsolete. �LSIGNA`i ED FACILITYTO O DESTINATION STATE(IF <br />