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ak Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved, OMB No, 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3, Emergency Response Phona 4. Manifgqest TrackingNumber p JJ 66 p� WASTE MANIFEST CAL00tita 344:334-2458 0 1 4789132 5. Generators Name and Mailing Address Generators Site Address (If different than mailing address) AR.hMARK 7679 c. LONGE ST STOCK:TON, CA. 95205 - Generators Phone:203-234-0105 6. Transporter 1 Company Name U.S, EPA ID Number PHILIP 61!ES1 INDUSTRIAL SERtACES CAR301177587 7, Transporter Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address WASTE Pdri NAGEh4EN1 KIETTLE%iAN LANDFILL US, EPA ID Number 3-5251 OLD SKYLINE ROAD _ CAT4t45117 KETTLEfJANh , CA 90'239 Facility's Phone: SA go. 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 (if any)) No, . Type Quantity WUVDL I. NON Rli HAZLARDOUS VVASTE, SOLID 001 CIA i5 Y , ;; 491 1 o LUrdDF,Y SLUDGE) z 2. uJ V h 3 I h 4. ' � I 14. Special Handling Instructions and Additional Information p d LINE1 : PROFILE: CASKIMS2 LAUNDRY SLUDGE ERGM71 tAflEAR PROTECnI VE, CLOTHING AND EYEINEA.R, 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 areclassitied, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable Inlematlonaiand national governmental regulations. If export shipment and l am the Primary Exporter, I cedilythal the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement idengfled in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (Ifl am a small quantity generator) Is true. G ratoeslOfiemrs PdntedTped Name SlgnaWr Month . Day Year 16. Inlernational Shipments '. i— Import to U.S. Ll Expert from U'S. Pmt ofentrylexil: z Transporter stgnalure (for exports only): Date leaving U.S.: w17. TmnspoterAcknowledgment of Receipt of Materials Tmnsooder 1 Printexii Name Signature Month Day Year ^ a Tmnspoder2P ledlFyped Name 'Signature Month Day Year F- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Pallial Rejecllon ❑ Full Rejection Manifest Reference Number: I Ob.Alternate Facility lot Generator) U.S. EPA ID Number V Facility's Phone: w Ise. Signature ofNlernate Facility (or Generator) Month Day Year B 19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) ® 1. / 2. 3, 4. 20. Designated Facillty _Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted in Item l PrintedRyped Name Signature Da . ✓ EPA Form 8700-22 fRev. 3-05) Previous e itions are obsolete. € MQ1Q .MA7Pn PA�ce ITV `Fea t§r: pip¢iateDvkY,