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<br />Form Approved OMS No. 2050-0039,
<br />Style CF 18 (AKL0 ASTR®(ap0)e2138pe w«w.leDNmmtx.can EPA Form 8700-22A (Rev. 9-88) Previous editions are obsolete.
<br />�mxrmaacro>;ev.wra� ORIGINAL -RETURN TO GENERATOR
<br />UNIFORM HAZARDOUS
<br />21. Generator's US EPA ID No. Manifest Document No.
<br />22. Page
<br />I Information in the shaded
<br />WASTE MANIFEST
<br />areas is not required by Federal
<br />(Continuation Sheet)
<br />C A N 1 1 1 0 0 1 0 4 4 1 2 0 8 3
<br />2 of 3
<br />law.
<br />23. Generator's Name
<br />L. State Manifest Document Number
<br />SAN JUAQtTT_N 001-TNTY
<br />AR 13,15223
<br />1810 E HAaLETON
<br />M. State Generators ID
<br />STOMTON, CA 95201 ATTN: ALISON HUDSON
<br />24. Transporter Company Name TIMEPA ID Number
<br />N. State Transporters ID
<br />0. Transporter's Phone
<br />26. Transporter Company Name 27. US EPA ID Number
<br />P. State Transporters ID
<br />0. Transporter's Phone
<br />29. Containers
<br />30.
<br />31.
<br />R.
<br />28. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number)
<br />Total
<br />Unit
<br />Waste No.
<br />HM
<br />No. Type
<br />Quantity
<br />Wt(Vol
<br />a.
<br />FLAt2ABLE. LIQUIDS,N.O.S., 3, UN1993, PO II, (gaeolinc,
<br />thinners), ,(erg: 128), (p£: .689979)
<br />..
<br />G
<br />N0.
<br />cilig,
<br />D.M
<br />�
<br />to
<br />b..
<br />_
<br />PAINT. aELAT®.t4CTERIAL, 3, UN1263,. PG II,. (acg: 1281, (Pf:
<br />744527).
<br />o
<br />!A
<br />D M
<br />HA
<br />G.
<br />CAUSTIC. ALHALI LIQUIDS, N.C.S., 8,. U191719, PO II,
<br />-
<br />(lab. -peak)., (scg: 154), (pf:. 744525).
<br />_
<br />Ig
<br />P
<br />Zr
<br />a,
<br />d.
<br />CAUSTIC AL X LIQUIDS, N.O.S., 8, UN1719, PG II,
<br />E
<br />(1.b -pack), (erg: 154), (pf:. 769885)
<br />N
<br />NA
<br />E
<br />R
<br />D F
<br />1 jj
<br />1 1
<br />NA
<br />A
<br />a.
<br />, 26
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<br />o
<br />NA
<br />R
<br />n
<br />.gnat
<br />NA
<br />f.
<br />xa+
<br />xD
<br />g.
<br />_ _
<br />m
<br />1?A
<br />It.
<br />,
<br />NA
<br />xm
<br />-
<br />I.
<br />AXMDNIUM NITRATE I:EATILItifSLS, 9, UN2071, PG III, (erg: 140),
<br />(pf: 744493) ...
<br />j'�,
<br />i.J\
<br />D F
<br />��
<br />D
<br />r
<br />LSA
<br />S. Additional Descriptions for Materials Listed Above
<br />T. Handling Codes for Wastes Listed Above
<br />y�1 _ rte,
<br />• 28A: 689979( i$`7c�SDM ) •» 288: 744527( 1 JX�j� Vim(
<br />2BC: 744525( 29D: 769885( 13YC—LA�)017
<br />EBB. il*46114 202. F44694t
<br />MO. 69848e( @of; 7446pmlE
<br />-.) *' 28Ie.. 744493(.��X—]l'Y J
<br />32. Special Handling Instructions and Additional Information
<br />wear appropriate PPE when xp
<br />handling hazardous materials. Job#.1483-(3�J2p 1
<br />waste is. Pf:RA a ealpt per..40 CER 261.4(b)(1) exclusion, Site: 7850 S. BA Bridgeford St., stookton,_cn.
<br />was paokedaccording tc 49 CER 173.12b /ERG Guide 128.,.154..-,.141 , 140 ,-.151 -
<br />T
<br />R
<br />33. Transporter Acknowledgement of Receipt of Materials
<br />Date
<br />A
<br />Printed/TypedName
<br />Sigture
<br />Month Day Year
<br />SR
<br />P
<br />4
<br />U
<br />05 016
<br />0
<br />R
<br />34. Tran porter Acknowledgement of Receipt of Materials
<br />Date
<br />T
<br />Printed/Typed Name
<br />Signature
<br />Month Day Year
<br />E
<br />R
<br />F
<br />A
<br />35. Discrepancy Indication Space
<br />c
<br />I
<br />L
<br />I
<br />T
<br />Y
<br />Style CF 18 (AKL0 ASTR®(ap0)e2138pe w«w.leDNmmtx.can EPA Form 8700-22A (Rev. 9-88) Previous editions are obsolete.
<br />�mxrmaacro>;ev.wra� ORIGINAL -RETURN TO GENERATOR
<br />
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