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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved, OMB No, 2050-0039 UNIFORM HAZARDOUS 1. GeneratorlDNumber2, Page.i of 3. Emergency Response Ph one 4. Manifest Tracking Number WASTE MANIFEST C; AL 0 0 0 4 0 5 5 g U � � _ " 011180919 JFK 5. Generators Name and Mailing Address Generators SlteAddress (If different than mailing address) ARAMARK 7079 S. LONGEST. STC>CKTON CA 952013 Generators Phone: ( 21219) 2321- 0051 6. Trans a r 1 zany Name r. U.S. EPA ID Number �,y ` 6x 1 /GL/ �� ,�� ' - Q3 s . Tronsporte 2C pany Name U.S. EPAID umber il. Designated Facility Name and Site Address U.S. EPA ID Number CHEMICAL WASTE MANAGEMENT, INC. 35251 OLD SKYLINE ROAD C A T 0 0 0 6 4 0 1 1 7 KETTLEMAN CITY CA 83238 _ Facilites Phone: go, go. U.S. DDT 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 WtNol. N0NRCRAHA ARDOLfSWASIESOLID q� .1 3, i r 4. f 14. Special Handling Instructions and Additional information d �� 33 7"7, Fry 1 . CAI908852 CHEMTREC CONTRACT # CCN241 .17 G� //30 6 rr q 15. GENERATOR'S/OFFEROWSCERTIFICATION: I herebydeclare that the contents of this consignmentare fully and accurately described shove by the proper shipping name, and are 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 export shipment and I am the Primary '.. Exporter, I c n ify that the contents of this consignment conform to the terms of Ills attached EPAAcknowledgment of Consent, I cerfify that 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 true. Generator' rots P nted/fyped araV e SlgnaNre ^ Month ay Year V 44 16. Imernmi nal Shipments r 1:1 import to U.S. El Export from U.S. Pod of entry/exit: z Transporter signature (for exports only): Date leaving U.S.: '.. W 17. TronspoderAcknowledgment of Re of Materials AK Trans PrintedRyped N me . Signature MonthDayYear off.. C,�°. Ir Qmash erg Pdnledrryped Name Month Day Year '.. F 4+ 18. Dlscrepancy . 18a. Discrepancy Indication Space ❑ Quantity [] Type ❑ Residue Partial Rejection on Full Rel ection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPAID Number J U Facility's Phone: '.. 18c. Signature of Alternate Facility (or Generator) Month - Day Year '.. Q 19. Hazardous Waste Report Management Method Codes (I.e., codes for hazardous waste treatment, disposal, and recycling systems) '.. ® 1, 21 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt or hazardous materials covered by the manifest except as noted in item 18a ` Printedllyped NameSignature Month Day Year Z `�Ur 0I I1� 1 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. ®ES1031AgATEM FACILITY TO DESTIMATION STATE (OF REQUIRED)