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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS7000205437 <br /> erator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST 1 510-541-2128 O+ 3 J £ FLE <br /> 5. era rs a and Mailing Address Generator's Site Address(if different than mailing address) <br /> °�u 51 ountry IUD 3131 erooksde Rd <br /> 3eo3 saint An-ore ws Dr Stockton,CA 95219 <br /> Stoc14 on,C A i�.^�1 t A <br /> Generators Phone: 209-956-8200 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Bq SkyEnveronmental Solutions (AL000348010 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> EQ in rde�uFsh ial Service MK 4366 642 742 <br /> 8 pbgreNf0�lYry Name and SrteAddress w.,..r..a,4.0: ,.o...,. .n,,.,.,.:. >,,. ,._.„..r» ...,,.U.S.EPA.ID Number <br /> H �-way!?512 miles south of Beatty <br /> Be wily,hN> T3 <br /> Facility's Phone: 775-653-2203 NVT3300100100 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol <br /> 1. 352 <br /> Er <br /> Nin RCRA Hazardous Waste Solid (01yDebris)cl DM 3a <br /> Z 2. <br /> LU <br /> 0 <br /> 3. <br /> 4. <br /> H' Heed p Instructions and Addti+2aaylnf9fmztprl. <br /> PrrCo•Clo*t'�`C070128300-11 2c30 1 I >I <br /> EMERGENCY CONTACT,EFF RHODES <br /> 15, GENERATOR'S/OFFEROR'S CERTIFICATION: Ifiereby declare that the contentsof this consig'riment are fullyand 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 governmental 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 EPA Acknowledgment 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)(if I am a small quantity generator)is We. <br /> Generators/Offeror's Printed/typed Name Signatu Month Day Year <br /> 5 chi 1 Z9 <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export fro S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Na �s /J Signature Month Day Year <br /> Z Transporter 2 PnntedlTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number, <br /> 18b.Alternate Faality(or Generator) U.S.EPA ID Number <br /> J - <br /> � Facility's Phone: Month Day Year <br /> w 18c.Signature of Alternate Facility(or Generator) <br /> ZZ <br /> 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> D 1' \ � 2. <br /> 3. 4. <br /> 20.Designated Facility Owner or Operator.Qertification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintediTyped Name Signature Month Day Year <br /> EPA Form 8700-22 ev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br />