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J <br />or .4 # .,. e,na ig: rm Aaeknnad fnr uea nn alifa 119.nR Ml fvnawritar 1 <br />11 n'3g7c_on.t FnrtnAnnrnvad OMR Nn 9ri_Sfi.Mt30 <br />EPA Form 8700.22 (Rev. 3.01) Previous editions are obsolete. - V' <br />10588.0234 DESOGNAII.EDFACILrffDE87IMATOONSVATE(OFREaUIRED) <br />UNIFORM HAZARDOUS <br />1, Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. Manifest Tracking Number <br />1 <br />WASTE MANIFEST <br />CAL000167732 <br />1 <br />800-424-9300 <br />000833496 G B F <br />5. Generators Name and Mading Address Generator's Site Address ('d different than mailing address) <br />Fedex Freight Fedex Freight West Inc <br />1805 Bast 23ad Street Suite 1 4520 South Highway 99 Frontage Road <br />Little Rock, AR 72206 Stockton, CA 95215 <br />Generators Phone: 501-376-7249 <br />6. Transporter i Company Name U.S. EPA ID Number <br />General Environmental Management,.Inc. CAD983649880 <br />7. Transputer 2 Company Name U.S. EPA ID Number <br />ttJ�tetto Cham nov', ddW U.S. EPA ID Number <br />Ur <br />11855 White Rock Road <br />Rancho Cordova, CA 95742 <br />Fadi 's Phone: 916 351 0980 CAD980884183 <br />ga. <br />9b. U.S. DOT Description (nduding Proper Shipping Name, Hazard Gass, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Ouandty <br />WLNol. <br />on-RCRA hazardous waste liquid (Cleaning <br />0Compound) <br />00 <br />om <br />P, <br />won-RCRA <br />hazardous waste liquid (Organic <br />0Liquids) <br />' <br />331 <br />�® <br />(J <br />oM <br />P <br />P <br />4. <br />14. Special,Handfing Instructions and Additional Information <br />1�( / x Approval #R30117 PRO #1440209536 <br />2) x S ) Approval fR30128 PRO (1616346664 <br />15. GENERATOR'StOFFEROR'S CERTIFICATION: I hereby declare that the contents of this oonsignmerd are fully and accurately described above by the proms shipping name, and are classified, packaged, <br />marked and tabeledtplacarded, 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 terns 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) (if i am a small quantity generatorl is tru <br />GeneratoeslOfieroes Printed/Typed Name Sgnatu MonthDay Y <br />S ®°l�r •�q'� V., <br />J <br />I- <br />16. International Shipments <br />1 ❑ Impart to U.S. ❑ Export fran U.S. Port of entry/exit <br />= <br />Transporter signature (for exports only): Date leaving U.S.: <br />� <br />IX <br />rarrsporter Acknowledgment of Receip of Materials <br />Trgftsporter 1 Printedffyped Na Sign re Man r <br />07 <br />Q:rr2PrintedfTypedN... <br />Iiignature Month Day Year <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Ouanfity ❑ Type ❑ Rewe ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J_ <br />V <br />raI <br />Facilitys Phone: <br />w <br />18e. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />Q <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e.. codes for hazardous waste treatment, disposal, and recycling systems) <br />®1. <br />2. <br />3. _ <br />4. <br />20. Designated Facility Owner or Operator. Certifeation of receipt of hazardous materials covered by the manifest except as n4V in Item 18a <br />Namer Signature Month Day Year <br />PA I I)AUW, <br />EPA Form 8700.22 (Rev. 3.01) Previous editions are obsolete. - V' <br />10588.0234 DESOGNAII.EDFACILrffDE87IMATOONSVATE(OFREaUIRED) <br />