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447368 Please print or typePr Zi In' (Form desianed for use on elite (12 -Ditch) tvoewritecl Dfl/OCeI7�� 0001 1307322 Form ADDroved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITYO DESTINATION STATE (IF REQUIRED) 10937.0012 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page i of 3. Emergency Response Phone 14. Manifest TracklFumb/e�r A 00 00 3442 4 2 Q,AT WASTE MANIFEST L 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) Fedex Freight FEDEX FREI6HT (STK) 4520 SOUTH HIGHWAY 99 FRONTAGE ROAD 4520 SOUTH HIGHWAY 99 FRONTAGE ROAD GeneraiSTMIGI1i CA 95215 (209)416-2121 STOCKTON 6. Transporter i Company Name U.S. EPA ID Number 21st Century Environmental 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number GENERAL ERVIROMITAL 96T, LLC IN PSC ENVIROHM TAL SERVICES 11855 WHITE ROCK ROAD Facility's Phone: ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol. 1. UN1956 WASTE AEROSOLS (LOOSEPR(3t AEROSOLS) 2.1 DOO1 331 w z. ill-RCRA HAZARDOUS WASTE SOLID (DAKIN6 POWDER) 101 DM 71 P 3. UN1133 WASTE RDESIVES 3 PGII 1001 281 X DM P 4. NON RCRA HAZARDOUS WASTE SOLID 352 DM P 14. Special Handling instructions and Additional Information (1) FEF208-00 - ERG(125) PROS 2110101693 AERO (2) FEFIOO-00 - PROW 2143213462 NON (3l FEF301-08 - ERG(128) PRO12290859151 ADHES (4) FEFIOO-00 - PROS 1882493002 NON 15. GENERATOR'SIOFFEROR'S CERTIFICATION: l 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 labeledrplacerled, 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 EPAAcknowiedgment of Consent. I certily that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) (b) (if I am a A quantity generator) is true. Generetor'sl0fferor's Prints yped Name Signatunt Month Day Year � A � �%d Yw 5- 06�� I- 16. International Shipments El Import to U.S. ❑ Export from U.S. Port of entry/exit! = Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Mate ' s Transporter 1 Printedrryped Name Signature / ® Month Day Year ALa CAP Z Transporter 2 Printedrryped Name Signature Month Day Ybar F- 18. Discrepancy 18a. Discrepancy Indication Space El Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number J_ Ca Lt. Facilitys Phone: LO 18c. Signature of Alternate Facility (or Generator) Month Day Year z y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4. H141 H141 H141 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in item 18a PdruedirrTed Name ignatureMonth Day Year t 11QN., R--4wx 1 (' 'L Q �' ,, G 1111 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITYO DESTINATION STATE (IF REQUIRED) 10937.0012