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c41.7"7B0.1.3 <br />lvpe.(Fw designed for use on elfie(12-path)IypewMerJ <br />16251(19 <br />c— e...... l MAP un 'AAA MOA <br />-0NIPORM HAZARDOUS WASTE MANIFEST <br />(Continuatlon Sheet) <br />2t. Generalar lONumoar <br />r, �.i I L.I ti i .3G � <br />Paga3 <br />0"; 3E. <br />23. ManNeal Tracking Numbm <br />000II614815DAT <br />24. Genen oes Name <br />SAN 1OAQUIN COUNTY DEPARTMENT OF PU➢LIC UORKS <br />18IC E HAZELTON AVE STOCKTON CA 95205 1209)468-3066 <br />25. Tramporler _ Company Name U.S. EPA IO Number <br />26. Transporter _ Company Name U.S. EPA ID Number <br />Val <br />HM <br />27b. U.S. D0170eseipgon(lneWing Pape+ Shipping Nam, Hazard Class, ID Numbar, <br />I>ag <br />and Padung Group (BanYD <br />28,Contsmars <br />29.7oW <br />Quantity <br />90. Unk <br />MAIDL <br />31. Wada Codes <br />No. <br />Type <br />u1U"rc ROL I • r; ^ .__:, _, <br />16 NON-RCRR WASTE; SOLID (SOIL/DEBRIS/RAGS CONTAMINATED WITH <br />OIL/PETROLEUM DISTILLATES) <br />CF <br />�/�"�*7 <br />Z.f/ <br />A <br />612 <br />X <br />(r-v4,v,"w1CaMn))L,i X11 ¢.% r <br />,,, <br />Z� <br />ep <br />� <br />19 <br />t.= <br />2D <br />---- <br />21 <br />22 <br />23 <br />24 <br />Ida <br />32. Handling Insduciens aoc AddigaW lntarmalbnttp.L-r cnih) 0 SOIL/ r -; (16) BED00102-00 - SOIL/FILTERS/DEBRIS: <br />17�61b=frowc <br />K <br />33. Tra poder_Advunled men( at Receipt ofhiatanals <br />O <br />a <br />Pdnte;yped Name Signature Month Day Year <br />z <br />36. TmnVOrIGE Admq menldReceiptafMenrvsl. <br />PdnI Jrryped Name Slgnaturo Month Day Year <br />v <br />LL <br />0 <br />w <br />35, Disuspanby <br />HeasrdousWeale Repot Management h7otlwd Cadw{I.o., calesfor harardeuawaste daaManL tlaposal, and recycling syslemsl <br />EPA Hom18700-22A (Rev 3-05) Previous editions ere obsolete, <br />DESIGNATED FACILITYTO DESTINATION STATE (IF REQUIRED) <br />