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195729-16 ' <br />PIPase mint or Nee. !Form cautioned for use on elite f12-oitchl Noewrlter.l <br />2506812 <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous edlions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. Manliest Tracking Number <br />000156954 DAT <br />WASTE MANIFEST CAH111001044 <br />1 <br />(877) 577-2669 <br />S. Generators Name and Mailing Address Generatofs Site Address (if different than mailing address) <br />SAN JOAOUIN CO. PUBLIC VORKS - ORIGIN: STOCKTON PHHOCF SAN JOROUIN CO. PUBLIC OORKS DEPT/STOCKTON PHWCF <br />1810 EAST HAZELTON AVENUE 7858 N.A. BRIDGEFORB STREET <br />Oeoemlors Phone: STOCKTON CA 95201 (209)461-3066 STOCKTON CA 95265 1209468-3866 <br />6 Transporter 1 Company Name LLS. EPA ID Number <br />21st Century Environmental Manavement of California LP CAR000210617 <br />7, Atari 2 Company Name U.S. EPA ID Number <br />` <br />e a>oa 5"b7 a- <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />RINECO CHEMICAL INC <br />1007 VULCAN ROAD-HASKELL <br />FaciResftorwr BENTON AR 72015 (501) 778-9089 ARD 1057870 <br />ba. <br />gb. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />17. Waste Codes <br />No. <br />Type <br />HM <br />and Padang Group (ffany)) <br />Quantity <br />WINol. <br />UN1253 PAINT RELATED MATERIAL 3 PGII dot-sp-11624 <br />512 <br />X <br />O <br />CF <br />��� <br />P <br />w <br />s. 091263 PAINT RELATED MATERIAL 3 PGII <br />612 <br />X <br />p <br />DPI <br />P <br />3. <br />4. <br />-f <br />14. Special Handling instructions and Additional In(mmalign <br />(1) 14➢SO5771-02 - ER61120) PAINT RELATED MATERI (2) 148585771-02 ER6(128) PAINT RELATED MATERIALL VASTE IS EXEMPT <br />HOUSEHOLD HAZARDOUS NOSIE PER 40CFN261.4b. n <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that Ne contents of this consignment are fully and accurately desuihed above bythe pmpet supping name, arU are dassfied. packaged. <br />marked and labeled/placarded, and are In all respects In proper condition for transport acarding to applicable imemalonal and national governmental regulations. If expM shipment and I am the Primary <br />Exporter, I ce2ty that the contents of this consignment confomt to the terms of the attached EPAAcknoMedgment of Conserv. <br />I witty that the waste minimization statement identified in 40 LFR 26227(a) (if I sm a large quandty generator) or (b) (iI I an a smell quantity generator) is We. <br />Gemrafoese0famus PdrdedfTyped Name Signature Month Day Year <br />� <br />!ciA-� -I <br />—16—Ime—mb-anTf Snipments <br />1:1 Import to U.S. ❑ExppA more U.S. Port of entrylexa: <br />Transporter signature (fair exports only): Date leaving U.S.: <br />CWC <br />17. Transporter Acknowledgment of Receipt of Materials ' <br />r� <br />ria'Poporda 1 Primetl/Typetl Nam re Mpdp Day ear <br />xq <br />i <br />G <br />TmnpDV2 PnntedR mefume Month Day Year <br />4 q /1 <br />♦ <br />18. Discrepancy <br />18a. Discrepancy Indication Spam ❑ Quantity ❑Type ❑Residue ❑Partial Rejection El Fell Rejection <br />Manifest Reference Number, <br />18b. Affemae Facility (or Generator) LLS. EPA ID Number <br />J <br />U <br />LL <br />Faciiii Phone: <br />w <br />like. Sgnsture of Alternate Fadliy(or Generator) <br />Month Day Year <br />a <br />z <br />N19. <br />Ha canlous Waste Raped Management Method Codes (i.e., codes far hauNous waste misheard, disposal, and recycling system) <br />G <br />1. <br />2.I 3. <br />4. <br />20. Designated Fadllry Owner ar 0peratar: Certification of receipt of lecardous materials covered by me manffesd exwpl as Wed in Ilem l8a <br />Printadflyyed Name Sgwtura Day Year <br />/i, c %% 717 <br />r y .. �. V/b <br />EPA Form 8700-22 (Rev. 3-05) Previous edlions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />