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Dldni nr 6mc' /9: r rice ncrr fnr i- nn elite 119_nitrhl tvnPwritor 1 Form Approved. OMB No. 2050-0039 EPdForm8700-22(Rev.3-05) Previous editiohsareobsolete. - DESIGNATED FACILITY TO GENERATOR UNIFORM HAZARDOUS 1. Generator ID Number AL 0 0 0 8 2 7 8 9 ? 2.1Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 000553584 J J K IM1'ASTE MANIFEST r:w Generator s Site Address (if different than mailing address) 5, Gene Ae41almVf • 91 - STOCKTON. '152.1 WE=ST C- . TER. VVXt TO10014.1ON A 06:2 Al Generator's Phone: 2.W ,3 .3-5930 6. Transporter 1 Company Name U.S. EPA ID Number ASBURY ENWROi`;WNTA4_ SERVICES C VAD 0 2 t3 2 7 7 0 3 �5 7. Transporter 2 Company Name U.S. EPA ID Number 8. DesignaatteO'lity e nea� i6AAd6ress U.S. EPA ID Number MIR ALANEDA. 3TTR.EET �^.i it, TON CA '22'-) C A 'x 0 3 0 1 3 3 y 0111 0)6Y7 -J1 100 Facility's Phone: 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. 1. I+?l WASTE RAJ INT 3 UN 11*03, PG II ZLU 2. 7Hu` W g� FOR RECYCLI t ;/ :... 3. e i C/KERt;OT CALIFORNIA. THI z 'AJ%.9 T Y 11'rt„ �>; 7 NEC" SSARY -------------- -? .�, ,. a.PERNIS 10 ,QUAUFIEI), OUR EPA HUMOER fg CA10gag13,'52 ---- 14. Special Handling Instructions and Additional Information q� � RVt/yl�y ��,y �rnyyr�ye �r ;) (�rt�p��q n❑yy + gfl�yr�� Of (f i . 1� * F1LE * A8 ...t)2�1 RN1N-T. t'' V A 1 0 7 J'j46FG ¢ r'�1 i":lO RIA I7-, f E{"1�7OM- ! ROTEO R �'��t.F PNEi`%T 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, 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a) Cf I am a large quantity generator) or (b) (if I am a qjjall quantity generator) is true. Generatoes(O%fferoes Printedfryped Name✓ ()� signaturre � r�� ✓, � �;,�,M th Day1/� Year /fi�.r'-•-•�-.�r � �! %r/r-°,.r f i�f ! /•'�'L..i.' ..s.'// ;l+c-- ✓/ �(/ `-l,�.i�/ .•lr.. F- 16. International Shipment ❑ Import to U.S. ❑Export from U.S. Port gfentry/exit: z Transporter signature (for exports only): Date leaving U.S.: Ix 17. Transporter Acknowle,dgme�pLt3eceipt of Materials _. - , CL Transporter1.Printedff Nae �f � f Signature;• s ,,--"� Month Day Year Q Transporter 2 Printed/Typed Name LSlgnatofe � - - �' Month Day :Near a 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity Type ❑ ❑ Full Re' ❑ T e ❑Residue Partial Rejection lection a - Manifest Reference • Number 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U Facility's Phone: LL, 18c. Signature of Alternate Facility (or Generator) Month Day Year a Z N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. 2' 3. 14. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Print yped Name y�r f """ " ' Signaturree'--+/'/' / :,a rte;- ' "'{� y Month Day Year r �,+�'F•�/'�.' i =•�-i �! � ".:J �,1 �'� �d � i!•��V' 1'"?A'✓' ' ".r� f' .%� iy�� ..T✓"�. r� t.+%i2-' �„�„„!��.,... �""..�^ ::.�')�� .li'�. EPdForm8700-22(Rev.3-05) Previous editiohsareobsolete. - DESIGNATED FACILITY TO GENERATOR