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KAC-p <br /> . j <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone JITICH <br /> WOOL <br /> WASTE MANIFEST CAL00026MI 1 14NW785.7225 44 vu FLE <br /> 5.Generator's Name and Malting Address Gemvator's Sile Address Gf dtiteremt than mailing address) <br /> Simpson Sfife inc. <br /> 5151 S AIRPORT WAY OF ALL HAZAADOUS a <br /> Stockton, CA 95206 MATERIALS BILLS AT LINE <br /> Generator'sPhone:91 SO TAB WILL ST{CK OUT <br /> A� tic ' ern coal Transport Inc. (SV) U.S.EPA ID Number C 'S40 <br /> 7.Transponer 2 Companyy Nam U.S.EPA 10 Number <br /> C4 Wily #= <br /> aro Address U.S.EPA 10 Number <br /> PO Box �f�+*Vyy�{9 11 Miles S Beatty NVT330010000 <br /> Beatty, W 6W03 <br /> r-adlty's Phone: 77S�S53-2203 <br /> go. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM <br /> and Packing Group(t any)) No. Type Quantity WLA101, 13.Waste Codes <br /> ohs Waste, .,(Ar89Wea Opp P D007 0004 D008 <br /> X Chromium),9,PG m , <br /> 0 D006 181 <br /> Z PAM 7 7,Hazardous waste,soffd,n.o.s. , <br /> PGlK <br /> D007 181 <br /> X I DM 7(op P , <br /> 4. <br /> 14.Special Handling Insftoons and Additional Information P%pet NLnber txnent I. D178511 <br /> 1) 0701283038032 SIU-.ov I t Ix �OT 3) 070128363.6013 SIU-j0L1C Y0Tr"ti) <br /> 2)ERO#171; 070128303-12123 Sit!--CgL-gkt J lam' 914) .s <br /> 15. GENERATOWSIGFFEROR'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, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport according to applicable International and national govemmentai regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAckn onseni. <br /> I that the waste minimization statement identified in 40 CFR 282.27(a)(if I am a large quantity )or(b m a emtor)is true. <br /> in N4no ign on y ear <br /> 78. ationai ShW <br /> F- TI import tu U.S. ❑Export from U.S. Port of entry!.'G <br /> z T nature for only): Date le U. .. <br /> IX 17.Tmn9p W Admowledgmenl of Receipt of Materials <br /> wSignature Mnffi Day Year <br /> Transporter 2 PrhMdfryped NameSign, <br /> ohUay Year <br /> t <br /> 18.Dia«apercy <br /> 18a.Distxepanq indication Space ❑Quantity ❑Type ❑Residueel *ft <br /> Partial R edion Full R.*ft <br /> Manifest Reference Number: <br /> 18b.Alternate Facilty(or Generator) U.S.EPA ID Number <br /> V <br /> W Facili 's Phone: <br /> 18c.Signature of Altemate Factiity(or Generator) Month Day Year <br /> 4 <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G i. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> rintedlTyped Nanm ` Signature Month Day Year <br /> 1 <br /> EPA Form 8700-22(Rev.3.05) Previoud editions are ob olete. DESIGNATED FACILITY TO DESTINATION STATE(IF RE I D) <br />