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'lease print or type.(Form designed for use on elite(12-pitch)Sr.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Pho 4.Manifest Tracking Number WASTE MANIFEST 005879641 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Lodi News-Senlanel 125 North Church Street Lodi CA 95241 Generator's(shone: =g :469 P811 6.Transporter 1 Company N5Me U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number Demennofti-doon CAT080013352 2DDD N.Alameda Street Campton,CA 90222 Facility's Phone: ya 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.Nol. i. o Non RCRA Hazardous Waste,Liquid(Waste oil) 00 �� G �a PP z 2. L c� 3. 4. 14.Special Handling Instructions and Additional Information 1.Waste oil ERC#171 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 concepts of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b (if 1 a s I a Intity generator)is true. Generator'slOfferoe P t ITy Name Signature r— Month Day Year OAI 46 1 -5-1 Z1 I f Z � 16.International SMpmerts ElImport to U.S. Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter P,pnted/T Name Signature Month Day Year O F'' IL W Transporter 2 Printed[Typed Name Signature Month Day Year Q F- 18.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 Facility s Phone: Q 18c.Signature of Alternate Facility(or Generator)12 Month Day Year Y S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 2. T- 20. Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba PrintedlTyped Name Signature a j Month Day Year i EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) 1 r