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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1•Generator ID Number 2.Page 4 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST GDF <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> JKC T}iUi r�7rsia <br /> 3400 NEWTON RD <br /> STC) KTON,CA 95:!05 <br /> Generator's Phon�o a 1-3219 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> AMERK:,AN WILIEY YtiA.S"fE 0%.INN CAR000272W2 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> `AhORLL W113E.RECOVERY SY:STEKS INC CAROW175422 <br /> 8.Designated Facility Name and Site AddressYLWAYES 2 VWASTk 1 KAPISFER l=AGIL,ITY U.S.EPA 10 Number <br /> &5W LAS 1-116)-WKY 05 AZROQ52114e <br /> �t uM.A�z n <br /> Facility's Phone4r28344-Z2t1 <br /> 9a. 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contalners 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity WI./Vol, <br /> 1• tX)N-RCRA HAZARDOUS WA^TF fiOLtCt,ARg0R8FWS. bif__ <br /> o PAF+FR FILTER, <br /> Q <br /> Lu <br /> Lu 2. I <br /> u i <br /> c.� <br /> 3. <br /> I <br /> 4, <br /> k <br /> 14.Special Handling Instructions and Additional Information <br /> Pl,'OFILE4 W Wfo Ili IRS A&'XjKlEt4i,#APER f11_TER(s ERG* 17 i <br /> Lh4E GENCY{:c7W'ACT- EF R IN <br /> 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, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applimbie international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cer*that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if1 am a small quantity generator)is true. <br /> GeneratorsfCfferor's PrintedlTyped Name Signature Month Day Year <br /> J 16.International Shipments <br /> � ❑Impart to U.S. ❑Expgrt from U.S. Port of entryfexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> 17,Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> Transporter 1 eq !Typed Name Signature�.� Month Year <br /> z Transporter 2 Printedrryperd Name Signature Month Day <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space <br /> ❑ Quantity ❑Type El Residue ❑Partial Rejection ❑Full Re}eetion <br /> Manifest Reference Number: <br /> 18b,Aitemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL. Facility's Phone: <br /> w 18c.Signature of Alternate Facillty(or Generator) Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> T3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 188 <br />` PrintedlTyped Name Signature Month Day Year <br /> PPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />