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i t Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 ' I UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number. >� j WASTE MANIFEST JJ 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) k1ft rdable Auto K Smog 121 S. w Keay. Stockton, 52"_5 Generator's Phone: fi.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA iP Number '.:'coyery systmes inc. 8.Designated Facility Name and Site Address US.EPA ID Number Facility's Phone: 928-344-982'z 9a. 9b.U.S.DOT Descripfion(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Jut: 13.Waste Codes HM and Packing Group(if any)) Na. Type Quantity Wt.Nol, 1. li _77 9 GailySolids'! 2t 2. LU 1 t i 3 f t } 4. s t i 14.Special Handling Instructions and Additional information AND qUS PID 15. GENERATOR'S10FFEROR'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 condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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)(if I am a small quantity generator)is true. Generator's/Offerors Printed/Typed Name Signature Month Day Year _t 16.International Shipments Z ❑Import to U.S. ❑Export from U.S. Port of on#rylexit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Ii Transporter 1 Printedfiyped Name Signature Month Day Year Q a T':i ;liii: v� Q Transporter 2 PrintedfTyped Name Signature Month Day Year [Y 18.Discrepancy 18a,Discrepancy Indication Space Quanfity ❑Type ❑Residue ❑Par#ial Rejection ❑Fufi Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA iD Number LL Facility's Phone: w ISo.Signature of Alternate Facility(or Generator) Month Day Year a ? Z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. _ _ 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedfTyped Name Signature Month Day Year i EPA Form 8700-22(Rev 3-05) Previous editions are obsolete. GENIERATOFt'S INITIAL COPY