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7100 S Longe St, Stockton Record ID PR0521732 <br /> 3/27/2019 <br /> Photo 2: Manifest number 006100090SKS (9/21/2018Lwas found without a signed off copy from the destination facility. <br /> designed for use on elite It2-pitch)rypewri!ar.1 4 Farm Appwed.OMB No.2C+`.AGN _ <br /> SUS I.GanBrelfrlPNumhar 2.Pagel of 7.Emergency Reaponee Phcne f.Ilei TncAine Nuerbx yr <br /> FEET <br /> SKS _ <br /> sEll Aasaing Add­ Generelors sileAdd— a men maa�cg addres9, { <br /> L> <br /> Ph ane: •. <br /> orter 1 Company Nome <br /> J.S EPA ID Number _ <br /> .Transppder 2 Company Name <br /> V.S. PAID umber - <br /> BDesignaletl Fanllily Name antl Silepddre55 r U.Sy EPA 10 Number <br /> Facirii Phbne: - <br /> 9a. Suu.S.DOT Descnption lincluding Fmper Shipping Name.Haza.JGlass.IDNumbe,. 10_Ccmalurs 1t.T-112,Und 13.wads Goba> <br /> HM and Fauing Group{irony{! <br /> 1 No Type Duantiry VA Mi. <br /> z 2. <br /> c� <br /> a <br /> 11.Special Handling InstrEpfioi-s apfAli InNrmadon <br /> "7.7 1 <br /> � �f`� E11C '( .`JC�{' 1�uu. .��Y1`j�rU—•C ' -rG �� ' <br /> [ if <br /> r <br /> 15. GFNERATCR'SfoFFERGR'S CERTIFICA ON Ih bl dells'ihal conlenla ofpisccnsignms are yBnd accurately esotbed above by the P.P.shipping name,old are classified:packagatl: <br /> markedandiE1,.1dlplarareeQ and are in all respects!n proper wndltlwl re,transport according to applicable inlernalional End nadonal go,emmenlal vNiulagons.Ir-pod shipment and l am the Primary - <br /> Expplter.i ceRlfy that the obntanta of this consignment canfilim to the tents of h1e attached EPA Aalu-1edgment of Consent. <br /> I cernry lhet ale waste mmimizatipn statement iden6fred in 40 CFR 262.27{al til I am alarge guan[ity generemrl or{bj(if I am S small quandry generator}Is We. ei��" <br /> Ga•neratEre✓Ilili RTntedTT ped Name Sigi Month Day Year <br /> 1 lntem9lienal Shipments —'^"- <br /> Imponfous. ❑Export tom U.S, Pertafenhywt -w <br /> - z Transporletsrgnature}far extorts onli'. pate leavkng U.S.: <br /> W f7,Tiann."l Achno•wledgmant Of Receipt O(MatellalE <br /> K JT,En,poner 1 PrintedRyped Name Si Monro Day Yearif <br /> JC <br /> Ira sporter2 PdnledlfypEd.Name Sign re r Mo fh Day Yeai '11\„`\,L\,111, <br /> as <br /> 8.Discrepancy O�,y <br /> 7ga,Discrepancy IntliraM1an Space ❑paanliry ❑Type ❑Resitlue ❑Pallial liejecuat ❑Full Rejecfion oO1p3�oO,AO�'). <br /> Manifest Reference Number <br /> 1&b_Aterpate Faciliy(or Genere!orj U.S.EPA ID Number <br /> U <br /> 12"Faclht)+s Rcm, <br /> F18c.SignaWre ofAllamaAe Facility(cr Generei Alonth Day Year <br /> 6 <br /> h19-Hazardous�Naste Repotl Management Method Cotles fi.a.,mdasfor ha2erCoas waste treatment,dieposal,andrecyclingsystemsl <br /> O <br /> 2D.Des gna'Pd FaeilRy Omer Er Operster.Caltda!lan o'receipt d hazardous materiels catered by the manifest excep!as need in Item li <br /> PdniedAyped Name Signadlre Mon!h Day Year <br /> EPA Form 87O-22(Rev.3-D5)Prevhi editions are obealere, GENERATOR'S lN1TlAL COPY <br /> Mi <br /> John Alaniz, REHS Page 2 of 12 <br />