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{_ 4]ldl�yll <br /> M Form Approved. OMB No. 2050-0039 <br /> Please print or type. (Form designed for use on elite (12-pitch) typewriter) , <br /> UNIFORM HAZARDOUS 1, Generator ID Number 2. Pagetof 3. Emergency Response Phone 4. Manifest hacking Number <br /> WASTE MANIFEST C A 9 0 9 4 u 9 5 i _ 01118 0904 JJ K <br /> 5. Generators Name and Mailing Address Generators SifeAddress (ifd'rfferent than malting address) - <br /> ARAMARK <br /> 7€79 S , LONGE ST. <br /> STOCKTON CA 9520€ - 0 <br /> Generators Phone: U.S. EPA ID Number <br /> 106 <br /> 6. Transporter 1C mpany Name r �7 <br /> I' ra f2 / ' � 5itr <br /> U. . EPA ID Number <br /> . Transpoder 2 Co pang Name <br /> U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address <br /> CHEMICALWA.STE MAt11A.GEMENT, INC. C A T 0 0 0 0 4 fs 1 1 7 <br /> :_5251 OLD SKYLINE ROAD <br /> KETTLEP WA C.v1T Y CA 93239 559 396- 1 <br /> Facilitys Phone: <br /> 9a. <br /> 9b. US. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br /> Type <br /> HM and Packing GNo. Quantity WLNol- <br /> Group (if any)) ff <br /> 0 1' NON RCRAH-AZA.RDOUS WASTE SOLID <br /> CM00252 � ✓ / "' <br /> w <br /> 3. <br /> 14. Special Handling ln;W::Kns and Additional Romanian <br /> 1 , C_A008852 CHEIVITREC CONTRACT # CCN24117 � � n <br /> C za5 <br /> GENERATOR'SIDFFEROR'S CERTIFICATION: Thereby declare Mat fl.- contents of ihisconsignmentare tally and accurately descn ed above by lh roper alons ifexpong ashi mentaam clasmth packaged, <br /> ( marked and labeled/placarded, and are in all respects in proper condition for hempen according toapplicebie tnlemafionaland national governmental regulalionsJfexport shipment and am the Primary <br /> Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenlof Consent. <br /> I andly that lhewaste minimization stalemenlldentified In 40 CFR 262.27(a) (if l am a large quantity generator) or (b) (III am a small quangty generator) line. Month DayYear <br /> G aloraloffamrs Pninded[Typed NameSign rn / , /6 <br /> V P Ig 40 �' �- <br /> 16. internationalShipments � Imporf to 0.S. ❑ Export from U.S. Porfofenhyexih <br /> f— Date leaving U.S.: <br /> z Transpodersignature (for exports only): <br /> w17. TmnspoderAcknowledgmentof Receipt of Materials Month Day Year, <br /> ` Tmns er1 PnntedlType N me - - 7 Signature ? <br /> r <br /> a �. 5 Month Day Year <br /> an Transporter 2 Printed yp Name Sig re <br /> K <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space quantity [-]Type <br /> ❑ Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> U.S. EPA ID Number <br /> 181n Altemat : Fac11flyfor Generator) <br /> U <br /> c Facilitys Phone: Month Day Yau <br /> w tea SlgnalureofAltemate Facility (or Generator) <br /> Q <br /> z <br /> N :0Desl9n:atedFaC:i11Jffvnrnri <br /> dWte Reort Management Method Codes (Let odes for hazardous waslefreaMenl, disposal, and recycling systems) 4 <br /> � � 2eralor. Cedificagon of receipt orhazar us materials covered by the manifest except as nded in Item i8a _ ^Type P4nTP 'eP � D Ya ' <br /> Priniedffyped Name I Signature <br /> aRe r <br />