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333506-16 Please print or type. (Form designed for use on elite (12-nitchl lvoewriter.l 2609201 C....., A.... '.. nx,ta e'- note noon " " DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number 2. Pagel of 3. Emergency Response Phone • x^^ • •rr•..... ... � •.� �...... 4. Manifest Tracking Number WASTE MANIFEST C4!H1110010Er4 I. (677) 577-'1669 ��Q DAT 6. Generator's Name and Mailing Address Generator's Site Address (f different than mailing address) SAH JOROUIN CO, PUBLIC UORXS - ORIGIN; STOCKTON PHHUCF SON JOROUIN CO. PUBLIC NORtS REPT/STOCXTON ow IOIO EAST NRZFETUW AVEME 1959 R.O. BRIMEFORU STREET Generators Phone: STOCKTON CA 95221 €299)450-3955 STOCRION CA 45796 6. Transporter 1 Company Name U.S. EPA ID Number 21st Centur Environmental Nanagement of California, LP CF1R000210617 7. Transpprter2 Company Nema U.. EPA ID Number S. Designated Facility Name and Site Address U.S. EPA ID Number LIGHTINS RESOURCES LLC 205 E. Francis St. Fadltbys Phone: ONTARIO, al 91161 (9e9) 920-1252 AR000156125 ga, HM nduding Proper Shipping Name, Hazard Class, ID Number, 9b. U.S. DEGroup(ff and Packin 10. Containers 11. Total 12. Unit No. Type Quantity WL.NoI.r 13. Waste Codes ON3OlOJ)IP1iY NRZa)RBOUS SU85TFJ7CE5,X €CRUSSCENT TUBES) 9 PGIII , CF 137 P z 2. w 3. 4. 14. Speclal Handling Ineworans one Additional Information II) SXM99442 - ERVIII) CRUSIfE➢ LIONT MIS. RLL 9ASTE IS EXEUPT 1N)USEOOLD MaRROUS U4)STE PER 4OCFR261.4b. 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 labeledlplacarded, and are in all respects in proper condlbon for transport according to applicable international and national governmental regulations. If expert shipment and I em 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) (if I am a large quantity generator) or (b) (ifI am a small quantlty, generator) is true. GenemtorslOBeaes Pdnledrr ed Name 6 Q d • Signature Month Dayp Year : x--Ohpm.n G L GLCI F /ci F— 16. International Ghipmenls ❑ import to U.G. ❑ Export from U,S. Part = of ent exit: Transporter signature (far exports arty): —Date leaving U.S.; w' 17. TranspaRerAdorowiedgment ofRecelpf of Materials oire er 1 PnMed/1'y Noma 1 n e Month Daypp Ye E Tran art Prin /Typed Name Signature Month Day Year r— 18, Discrepancy 18 a. Discrepancy Indication Space ❑ Quantity ❑T e yP El Residue ❑ ParBal Re)ection ❑Full Rejection Manifest Reference 16b. Alternate dorNumber: Generator) J U.S. EPA ID Number U W Fatuity's Phone: 18c. Signature olnumale facility (or Generator) Month Day Year z z W1g. Hazardous Weste Report Management Method Codes (i.e.,codes for hazardoes waste treaknent, disposal, and recycling systems) 1. 2. 3. 4. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manliest except as noted to Item 180 Printed7fyped Name Signature Month Day Year 2PA Form 8700-99 (Revedge...,.. ......r...,.i..._ " " DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)