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RECEIVED <br /> By Christine Lawrence at 2:21 pm, Oct 15, 2019 <br /> Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A D 9 8 3 $ 1 8 7 2 3 844.33+1'2466 019514628 JJK <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> PAC 'r-GAS 4,ELECTIIM PG&E SELLWASUBSTATATION <br /> PO BOX 764G FLOOD RD 112 ML W OF ESMON <br /> SAN PRANUSCO CA 94120 LINDEN CA 95M <br /> Generator's Phone: 2 0 9 3 2 3 9 6 1 7 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> PHILIP WEST INDUSTRIAL SERVICES C A R 0 0 0 2 0 9 5 4 8 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desi nated Facility Name and Site Address _ U.S.EPA ID Number <br /> 994119 S.AUSTIN RD <br /> MANTECA CA 96336 <br /> Facility's Phone: 209 9f2'424 �i A L o Q Q 1 9 �A 0 8 <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 Wl.Nol. <br /> 1.RO�NA2212,�Asbeta I � <br /> o ` 9,P11M 1( <br /> LU <br /> LU 2, <br /> LU <br /> 0 <br /> 3. <br /> 4. <br /> 14. ci I JI 1nsir c'o s <br /> jg <br /> C i j,I ormation { <br /> t� �. i►-�. �r�l' ft - San Joaquin Valley-APCs -'`� r�.t . _ <br /> JVB# 1221611-0026-JOOOB 1990 E. Gettysburg <br /> Fresno, CA 93726 <br /> JON <br /> 15. GENERATOR'SIOFFEROR'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)(if]am a small quantity generator)is true.. <br /> Generators/Offeror's Prinled[Typed Name r, �4e1 4,L F= O r' o`-1 Signature Month Day Year <br /> s �� v.g I d <br /> -_ <br /> 16.International Shipments // <br /> F <br /> Ll import to U.S. ❑Export f6e .S. Pod of entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TranspdrterAcknowledgment of Receipt of Materials <br /> LU <br /> '-- Transporter 1 Printed/Typed Name Signature Month Day Year <br /> a <br /> aTransporter 2 Printedfryped Name Sj uro Month Day Year I <br /> o' li <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection A <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Facility's Phone: <br /> fa <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> m19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. 4. <br /> 20.De gnated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest exce t as nded in Item 18a <br /> Printed/Typed an / Signature / Mo h ay egr,� <br /> EPA Form 8700-22(Rev.12- 7Previous editions are obsolete. ( 1 DESIGNATED FACILITY-110 GENERATOR <br />