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01 <br /> Form Approved.OMB No.2050-0039 <br /> Please print or type.(Form designed for use oh elite(12-pitch)typewriter.) anse 14*11013011031 TraCK11 <br /> UNIFORM HA�ARDOUS Generator ID Number Ch.L000244-61t 2.Page 1 of fiBsponse Phone ig Number <br /> FEST 1-800-468-1760 001027820 -SKS- <br /> VASTE MAN FEST s Site Address Of different than mailing 5.Generator's Name and Maling Address Generatoraddress) <br /> 140141ER LIF-ETILE <br /> 342 ROTH ROAD AATN: riNANCE ADMIX <br /> LATHROP CA 95330 <br /> Generator's Phone: 209-963-1500 1 1. U.S.EPA ID Number <br /> 6.Trar art Co Name <br /> CW -15 SYSTEMS, INC, <br /> I Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Nam and Site Address SA]T-'ETY-F.L0.t*I SYSTEMS, IN-- <br /> U.S.EPA ID Number <br /> 1000 SOUTH I ST CA 93654 <br /> REEMET CAD093459485 <br /> 559-630-3010 <br /> EacloFacill <br /> t es Phone: <br /> ga. 9b.U.S.DOT Description Oncluding Proper Shipping Name,Hazard Class,10 Number, 10:Containers 11.Total 12.Unit, 13.Waste Codes <br /> HM and Paddrig Group Of any)) No. Type Quantity Wl].Nol. <br /> It 1-CORBU M- BLE -LIQUIDS -N-O.S. DK. <br /> 6 213 <br /> 0 ('.DECAMMYLCYCL--'OP.ENTASILOXME:) <br /> UJ <br /> = . 2. <br /> ur <br /> 3. <br /> 4., <br /> 14.SF(TI_Kqndring-Insi�and Additional Information SK TKI-4109269111 0001697089 <br /> SK AtiTHORIZED TO RETAIN LICENSED SUE19EPUENT CARRIERS AS NECESSAIrY <br /> 15. GENERATOR'WOFFEROR'S CERTMATION:I hereby declare that the contents of this consignment are fully and accurately described above the proper shipping name,and are classified,packaged, <br /> marked ihd labdi"placarded,and are In all respects In proper condition for transport according to applicab"ternational and national qovemmen1aI,'MgWa0ons;'.If aW sUpment and I am the Primary <br /> Expodef;l certiiythatihe contents of this consignment conform t6-the[arms of the attached EPAAcknowledgmentof Consent. <br /> Ice*that the waste minimization statement Identified in 40 CFR 262.27(a)Of I am a large quantity generator)or(b)(fl-am a small quantity generator)Is true. <br /> CoeneratorVofferVs PdntedrTyped Name Signature Month Day Year <br /> J se. <br /> ' <br /> S. ❑ xpot from U.S.US. <br /> Potof entry/exit <br /> Transporter signature(for exports only): Port <br /> Waving U.S.- <br /> 17.TrOnSpDdetAdnowledgment of Receipt of Materials <br /> UJ Mon. Day Year <br /> t2 Transporter 1 PrintedRyped Name SI 3 <br /> co - - 17" <br /> Transporter 2 Printedfl yped IU= S'nature Month Oay Ye <br /> L <br /> 18.Discrepancy Residue ❑Partial Rejection ❑Full Rejection <br /> 18a.Discrepancy Indication Space El QuantityType F <br /> Manifest Reference Number. <br /> 18b.Aftemate Facility(or Generator) U.S.EPA ID Number <br /> u- Facility's Phone: <br /> 18c.Signature of to Facility,(or Generator) Month Day Year, <br /> w <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatmerit'disposal,and recychng system) <br /> 2. <br /> 20.Designated lity Owner or Operator.Certification of receipt of hazardous materials covered by the manifest-except as noted in Item 18a <br /> YPad Name Signature Month Day year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY'S COPY <br />