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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number C WASTE MANIFEST M000 205 437 1 5 10-54 u .2 i i 8 1 ,3 A ►>r l$ I� E 5.Ggr fatQr�s�a end tytai ing dress Generator's Site Address(if different than mailing address) ;.t 3111 Brooks id,- Rd Stm-kian,c;A 01 'r+' Stockton,CA 95219 Generator's Phone: 209-9.5154200 6.Transporter 1 Company Name U.S.EPA tD Number Rig Sky Envtmnmerdai Soiubans M 00 oue 01 o 7. orter 2 Compan Name U.S.EPA ID Number EO Trans�nchrsl! � etvic a MIK 435 842 742 8.Dp.p4r#tAF4ISty Name and Site Address U.S.EPA ID Number HtyI-ay 45 12 rrltkas south of 99A'lly O&Mly,N\!Nt4t1(r Facility's Phone: 775-653-2203 NVT330010000 9a. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1' 352 o Non RCRA Hazardous WaNe SW(01y Debris) q Z 2• t c7 I 3. t I 4. I V,P Hp fvinstrucbons and Add" dV9fWIT1 PtuNr_ # 070148300-11230 EMERGENCY CONTACT.TEFF RHODES 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, marked and labeled/placarded,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. Generators/Offerors Printed/Typed Name Signature' Month Day Year J 16.International ShipmentsC� El Import to U.S. ❑Export from ITS. Port of entry/exit: ` ? Transporter signature(for exports only): Date leaving U.S.: W 17 Transporter Acknowledgment of Receipt of Materials OTransporter 1 Pnnted/Typed Name ( y }r Signature �/ Month- Day Year a �• s z Transporter 2 PrintedlTyped Name Signature Month Day Year F 18 Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Fac lity(or Generator) Month Day Year r— Z S219.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PnntedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY