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- C17t�Trr$i Please print or type. (Form designed for use on elite (12-pitch) typewriter.) l 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 CAL 0 0 0 4 05 � S � � 011180910 J3K S. Generators Name and Mailing Address Generators SiteAddress (if different than mailing address) - ARMAAHK 7570 S. LONGE ST. STOCKT,ON CA i Generators Phone: 20011 23L 0105 6. Tran ode $Company Nam �t U.S. EPA IO Number - PVWV 7. TremsfJWr2 Centrally Name 0.S. EPAID Number B. Designated Facility Name and Site Address U.S. EPA ID Number CHEMICAL `NAS7E MANAGEMENT, INC, 35251 OLD SKYLINE ROAD C A T 0 0 5 6 4 0 1 1 7 K fTLEPA N CITY CA 93239 Facility's Phone: t 5 Ul .1PO— 07 14 ga 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, �1Type Quantity WI.Nol. 0 1' NON FICA HAZARDOUS WASTE SOLID L r � CABE18852 15 ygg 9 3. 4 - =t 14. Special Handling lnstmclions and Additional Information 1 . CA.006552 CHEM T REC CONTRACT 0 CCN24117 vAk r4�CZ� QwQlq 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, 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 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I cedlly 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. Ge for tferor mdedffy ed N Signet Momh Day Year ..r 16. International Shipments I— ❑ Impodto U.S. ❑ Export from U.S. Pod of entryfexit. Transporter signature (for exports only): Date leaving U.S.: w 17. TranspoderAcenowledgmentof Receipt OfMal0da13 Trans rt rt Printed�ed Name Sign Month Day Year O EL 0) Transpoder2 Printed/Typed Name Signator Month Day Year h 18. Discrepancy l8m, Discrepancy lndleation Space Quantity []Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181h.Alternate Facility (or Generator) U.S. EPA ID Number J U rea. Faciiity's Phone: T8G' ignature of Alternate Facility lot Generator) Month Day Year Q Z wig. Hazardous Waste Report Management Method Codes i.e., modes for hazardous waste treatment, disposal, and recycling systems) w 1 2. 3. 4. 20. Designated F cillty Owner or Operator: Cedificationef receiptof hazardous materials covered by the manifest except as noted in Item 18a PrintedfTypeda e Signature Mppl,Il Da Year Yv9 ��w l/l)d) �l1 EPA Form 0700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)