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J <br /> `Please print or type.(Form designed for use on elite.(12-0ch), ewrifer.) PormApproved.OMB No..2454 443 <br /> UNIFORM HAZARDOUS- <br /> WASTE <br /> AZARDOUSWASTE MANIFEST ..%A.-flIM35571 r 1 1&82.3-$"72 FLE <br /> 5.Generator's Name and Mailing Address creta a Site (ddferent than mail ng zees) <br /> I-OVEffSAL SVC RECYCLNG Ain>VlWm 1vlendonCa <br /> -3OorndoSt, <br /> Stockton,CA <br /> Generator's Phone: <br /> 6, ranspoiter1 Company Name U.S.EPA 15 Numb <br /> 7.Transpn lar 2 Company Name <br /> U.S,EPA ID Number <br /> 8:Designated Facility Name and She Address U.S. IO:Number <br /> i 11 i 4 West H%hvmy 1123 UTC09301226i <br /> FaciWs pno €4-4451 east Car,UT W20 aim <br /> 9a. 9b.U.S.DOT Description(inducing Proper Shipping Narne,Hazard Claw,ID Number, 19.Containara 11.Total 12.Unit 13. � <br /> HM and packing Grp p(dany)) No. Type Quan' WtNol. s <br /> o. <br /> KnRCRA HAL4WOUS WASTE,SCUD i 04T riagaf d) OM HG ��. "'T <br /> a <br /> rr <br /> U3 2. <br /> Uj <br /> 3. <br /> A. <br /> A Special Handling Instructions and Additional Information �s j <br /> 10,41 z&Aj- k\4CE W-CYCUNG PROJECT RAILCAR No, (,,j <br /> n n-pVR4'sitraw"kasidw <br /> ECDC PRO. 141 1E 84W ` <br /> 15. GENERATOR'S!OFFEROR'SCERTIFICATION:IharebydedmthatthecgrtentEofthisconsignmentamfiuly.eMatt�ustetydescxW6b.ov4byttrapmparshiWng, ams,a6d0eidassified,pedc&ged, <br /> madced and.labeledfplacarded,and are in all respects In propefc onct o i for transport aamrtiiryg:loapplkxbie intamabonat and national govemmardal regulations.If export shipment and l am the Primary <br /> Exporter,Ice*that the contents'rrf drs consignment conform to the tnmrs ate atlached EPAAdcWm*mam of Consent <br /> I certify that the waste m'nlmizabexc sbtament Identified In 40 CFR,262.27(a)(d I am a.hge quantity go.narator)or(b)(if.I am a small quantity ganwator)is two, <br /> ena atac sPrintedfTyped Noma re , qty ear <br /> E <br /> t `a 16.in amai w a!Shipments <br /> r ❑import to-U.S, ❑Expon from U.S. Port of.entry/exit <br /> Tra rs3 etura for ex on Date lsavi U.S: <br /> „7sarrsperterQcip <br /> E _ <br /> er Y Pn <br />$ T Yom, �✓' ,�j �` .. �.._ (�,'� <br /> a l r € d 441 D <br /> Z Tmnspodu2 Print yped Name nature Year <br /> 18.Discrepancy <br /> 18s.D scropancy indication space El Bfj ❑T p. ResidueD P Raodoh LJ�ry <br /> Fit Rejection <br /> Marftl ReWenw Number: <br /> 18b.Aitemale Facility(or Generator) U.S:EPA ID Number <br /> J <br /> v <br /> LL Facifi s Phone: <br /> LU 18c.Signature ofAftemate Facility(or Generator) Month' Uay Year <br /> Z <br /> 3 19.Hazardous Waste Report Management Medcod Codes(Le.,,codas for hazardous waste treatment,disposal,and*yding systems) <br /> n 1' 2• 3, 4. <br /> 2Z <br /> D `nated adi Owner or Operator.Carti8ca4an of <br /> i�9 dY receipt of ta¢ardous mawmis covered b5'the manifest except as tidied in ttsm 184 <br /> PriNTTyped Nameignft' <br /> re th. DAY Year <br /> -� -xf " <br /> EPA Form 8700.22(Rev.3.05) Previous edrtfaris are absclafa. 1Z <br /> DESIGNATED FACILI Ta GENERATOR <br /> k - <br />