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C:':` AI <br /> Please print or type. (Form designed for use on elite (12-1 typewriter.) Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2. Page l of 3. Emergency Response Phone 4. Manifest Tracking Number g� <br /> WASTE MANIFEST +.: A, L Q D Q Q 5 5 0 $ BQQS 41 �$- 9300 ® ® 9 Js� B® <br /> 5. Generators Name and Mailing Address Generators Site Address (if different than malting address) <br /> ARAIM RK <br /> 7079 S. LONGE ST, <br /> STOCKTON CA 95205 <br /> Generators Phone: . jgy . ,- ,o 5 <br /> 6. Transp r o pony Na a I - 'L F U.S, EPA No e 1 <br /> 7. Transpoder2 Company Name ,�Zl' �Rj \�' U.S. EPA IDNumbe, <br /> 8. Designated Facllity Name and SKeAddress U.S. EPA ID Number <br /> CHEMICAL ` VASTE MANAGEMENT,T, ING. <br /> 35251 OLD SKYLINE 90.A..C3 C A T 0 Q Q 64 E 1 1 s <br /> ({ETTLENIAN CITY C.W` 03239 <br /> Facllity's Phone: 550 3'ICE 97 .11 <br /> 9a. 6b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12, Unit 13. Waste Codes <br /> HM and Packing Group (If any)) No. Type Quan ly Wt.AI '.. <br /> oc 1' NON RCRA HAZARDOUS WASTE SOUR <br /> r I40� AEL <br /> E � <br /> 3. <br /> 4. <br /> III Handling instructions and Additional Information <br /> 1 . CA6150u52 CHEtvITRCC C-IJNTRACT = C CN278117 <br /> 15. GENERATOWSIOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> 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 <br /> Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(x) (if I am a large quantity generator) or (b) (If I am a small quantity generator) Is true. <br /> GenemforslOHerors PrintedfF ped Name sign re Month Day Year <br /> J 16, International Shipments - <br /> Impart to U.S. ❑ Export from US. Port of entrylexll: <br /> Transporter signature (far exports only): Date leaving U.S.- <br /> WW 17. TransporterAcknowledgment of Receipt of Materials <br /> Trans ad r Pto yped N I Sig m Month I Day Year <br /> MTransporter 2 Printedped Name Slgnat e < Month Day Year <br /> h <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 186. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> 1Be. Signature of Alternate Facility (or Generator) Month Day Year <br /> B <br /> y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ® 1 2. 3. 4. <br /> 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedflyped Name Signature Month Day Year <br /> �l r a 1K . (el <br /> EPA Farm 8700-22 (Rev. 3-05) Previous editions are obsolete. 0ESIGNATC0 FAA. R.6TV T€b nP—gTIRIATInm -QTATr. 6IP CgpnI naniff n1 <br />