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Please print or type.(Forth designed for use on elite(12-pitch)typewnter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 1 JJ K 5.Generators Name and Mailing Address Generators Site Address(h different than mailing address) VL;6111 3""l MODFST0 CA 95354 2714 STAGECOACH Generators Phone: STOCKTON 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number STEM INC. 8.Designated Facility Name and She Address U.S.EPA ID Number r ;:nrEINFNI u:. GaOO US HIGHWAY 95 YIIMA A'r'. A/ROC.t05211 Facif s Phone: ?9" hi 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(I any)) No. Type Quantity WtN& 1., i1 ;5d K 0 F)ft1 J z Z. W PJ - 3. 4. 14.Special Handling InshucfionaandAddifiorW Information EMERGENCY CONTACT'CHEMTREC 1-800-424.9300 WOES TERMINAL CEDES CS "PROFILER 981 : 1VC °:NRS71100? PAPER FILTERS * APPROPRIATE PPE EQUIPMENT K, C 15. GENERATOR'SIOFFEROR'SCEIMFICATON: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,aid are desisted,packaged, marked and labeledfptacarded,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 EPA Acknowledgment of Consent. I cal that the waste minimization statement identiried in 40 CFR 26227(a)(if I am a large quantity generator)or(b)If I am a small quantity generator)is We. Generators(Ohemrs NntWffyped Name Signature Month Day Year I —11 16.International Shipments i— ❑Import to U.S. ❑Evart from U.S. Port of entryfe)it = Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAdmowledgment of Receipt of Materials Tmnsporter 1 Printedrfyped Name Signature Month Day Year O a , Transporter 2 Printe ltrype l Name Signature Month Day Year fY F } 18.Discrepancy like.Discrepancy Indication Space ❑ Quantity ❑Type ❑ I ❑Full Rejection ❑Residue PaNal Re'ection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facilitys Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedRyped Name SignaWm Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY