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C. 04010. 1713 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000414604 209-389-2781 014373655 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Central Valley News Sentinel 125 N.Church Street P.O.Box 1360 Lodi,CA 95240 Lodi,CA 95241-1360 Generators Phone: 209-399.2701 6.Transporter 1 Company Name U.S.EPA ID Number Calil`omia Environmental 8 Litho CAR000009910 7.Transporter 2 Company Name U.S.EPA ID Number Rust and Sons CAR000187922 8.Designated Facility Name and Site Address '/ '/� U.S.EPA ID Number 5375 S.Bayle Avenue CAD007030993 Los Angeles,CA 90058 Fadlitys Phone: 323-277-1500 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group If any)) No. Type Quantity wtNol. 13.Waste Codes 1. Non RCRA Hazardous Waste,soNd(Waste ink contaminated debris) CF P 352 001 None Z 2. w t9 3. 4. 14.Special Handling Instructions and Additional information 1.Waste plastic buckets,debris with ink # ERG#171 _7 D07 Pa-l0 3Q� 15. GENERATOR'S/OFFEROR'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 tNs consignment conform to the terms of the attached EPA Acknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(f I am a large quantity generator)or(b)(d I am a small quantity generator)is true. Generetgjs/offeroes Pdnted/Typed Name Sign toa Month Day Year SO f pl ! Cq 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/axil: =1 Transporter signature(for exports only): Date leaving U.S.: It 17.Transporter Acknowledgment of Receipt opjliterials 43 TransppW%pQyed Name Signature Month Day Year a Z Transporter 2 Printedrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Spare ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 181d.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z y19.Haze us Vyaste Report Management Method Codes(i.e.,codes tar hazardous waste treatment,disposal,and recycling systems) G 1. y 2 3. 4. 20.Designated Facility Owner or OyipratorCertification of receipt of hazardous materials covered by the manifest except as noted in Item 18a nntedrr pe Name Signature Month Day Year Z EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) 12470.1816