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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved, OMB No, 2050-0039 UNIFORM HAZARDOUS1. Generator lD Number 2. Page l of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 4 (} $ 5 9 5 � 800) 424- 9300 011180918 JJ 5. Generator's Name and MolingAddress Generators Sim Address (if different than mailing address) ARAIrAARK 7670 & LONGE ST, S T OCIffON CA 9.5266 Generators Phone: 6. Transporter 1 Company Name U.S. EPA ID Number - &bpse 7. Ira sporter2 Co pany arae J � �E e, U.bVR .S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPAID Number CHEMI CAL WASTE MANAr EIVIEN T, INC. 35261 OLD SKYLINE ROAD CAT 6 6 6 6 4 8 1 1 7 , KETTLEMAN CITY C.A @3239 Facility's Phone: If 5691386- 97 '11 ga. 9b. U.S. DOT Description (including ProperShipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit HM and Packing Group illNo. Type Quantity Wf.No . 13. Waste Codes o NON RC'RA HAZARDOUS WASTE SOLID R EE \ � rJ 2 625a I ca u -� _-j�_ tltl 3. gg 4. 14:Special Handling Instructions and Additional Information i . CA608862 CHEW REG CONTRACTOCCN24117 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this censignmenl are fully and accurately described above by the proper shipping name, and am classified, packaged„ marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable international and national governmental regulations. If expod shipment and l am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknmvledgment of Consent. I certify (hat 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 generator) Is free. GeneratorsfOfeerrors P 'n y ad Man Signa Month Day Year IAAA—a 16, InternationalShipmentsy1frpli r ❑ Import to U.S. ❑ Export from U.S. Pod of entrylexit: Transporter signature (for exports only); Date IeaNng U.S,; our 17. TmnspoderAcknowledgment of Receipt of Materials Transporter 1 Prinfedlfyped Name Signature Mo Ih Day Year Z Transporter 2 Pnntedffyped NameSi ature Month Day Year 18. Discrepancy Its, Discrepancy indication Space ❑ Quantity ❑Type ❑ Residue El Paris[ Rejection 1 ❑ Full Rejection Manifest Reference Number: 1Bb.Alternate Facility (or Generator) US, EPA ID Number J U Facility's Phone: w 18c. Signature ofAllemale Facility (or Generator) - r Month Day Year Q N19. Hazardous Waste Report Management Method Codes (i.e.) codes for hazardous waste treatment, disposal, and recycling systems) p 1 . 2. 3. 4, 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted in Item Its Printedfiyped Name Signature Month Day Year Month t2 , Lv I EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete. DESIGNATED FADILI`FVf TO DEST•INATI®N STATE 9IF REQUI RED1 a