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If <br />r <br />tti <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />4. Magfe�t Tr�clu� 2 6 6 6 <br />0 o Z <br />_ <br />T <br />I <br />( <br />t (Form designed for use on elite (12 -pitch) typewriter.) <br />Fedex Freight Fedex Freight West Inc <br />187014-204 Form Approved. OMB No. 2050-0039 <br />r�caac type• <br />Kiln 0 <br />UNIFORM HAZARDOUS 1 Generator ID Numi�r <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />4. Magfe�t Tr�clu� 2 6 6 6 <br />0 o Z <br />WASTE MANIFEST CAL000167732 <br />800-424-9300 <br />FLE <br />5. Generators Name and Mailing Address Generator's Site Address (if different than matting address) <br />Fedex Freight Fedex Freight West Inc <br />1805 East 23rd Street Suite 1 4520 South Highway 99 -Frontage Road <br />Little Rock AR 7J206 Stockton, CA 95215 <br />X501 <br />Generator's Phone: -3T –7249 <br />6. Transporter t Company "am"U.S. EPA ID Number <br />General Environmental Management, Inc. CAD983649880 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />g %Fa,;ytd Nab,_ a„rt o Adddresuc U.S. EPA ID Number <br />11855 white Rock Road <br />? 0980 42 <br />Rancho Cordi'35 <br />96 =980884183 <br />Facility s Phone: <br />9a <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12, Unit13. <br />Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />WtJVOI. <br />F331 <br />1.UN Waite Paint related material, , III <br />D00 <br />0 <br />X <br />0 <br />DM <br />G <br />z <br />2. <br />w <br />3. <br />4. <br />14. Special Handling Inst runs and Additional Information <br />1)t c x T6 D Approval #R27033 nG: 128 PR0#1731573734 <br />15. GENERATOR'S/OFFEROR'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 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) ('d I a small quantity generator) is true. <br />Generato s/ i—rtedrryped y Name rig fe <br />on ay ear <br />S <br />ij <br />16. Intemaknal Shipments❑ Export from U.S. Port of entry/exit: <br />Imlort to U.S. <br />= <br />Transporter signature for exports only): Date leaving U.S.: <br />IX W <br />17. TransporterAcknawledgment of Receipt of Materials <br />O <br />ggay ear r <br />Trans orter 1 PnntedrT ped Name + t ignatu o /5-10-/ <br />I '�i S d <br />a <br />1r' ve— �lt� It ► / <br />Q <br />Transporter 2 Printed/Typed Name gni re on ay ear <br />18. Discrepancy <br />18a. Discrepancy Indication Space Quantity Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />v <br />Facili 's Phone: <br />W <br />18C. Signature of Alternate Facility (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 />wo <br />1 � � <br />2. <br />3. <br />4. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest ex t as noted in Item 18a <br />Signature Mon pa <br />EPA Form 8700-22 (Rev. 3-05) Previous aQions are obsolete. " t; "'"DE5Tf,PlATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />10482.1863 <br />