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CMI 11 dr Please print or type. (Farm designed far 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 Phone 4. Manifest Tracking Number WASTE MANIFEST o f A L 0 0 0 4 0 5 5 99 5 - an 1180903 JJ K 5. Generators Name and MaifiagAddrass GenemtoeS SiteAddress (itamerent than mailing address) ARAMARK 71575 S. LONGE ST. STOCKTON CA55206 Generators Phone: ' `7 '3' F 6. Transporter 1 Company Name , "e ¢\� � + U.S, EPAlp N minor 7. ransporter 2 Company Name U.S. EPAID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number CHEMI CAL WASTE MANAGEMENT, INC. ?5251 OLD SKYLINE ROAD CAT 0 5 0 6 4 5 1 1 7 KETTLEMAs\ CITY CA 93239 Facility's Phone: ' a 9 — R— •1 i '',. 93. Its. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Padding Group (e any)) No. Type Quantity Wtivol. NON RbRAFIA ARDOLIS 'vi?bSTE SOLID ® p 0 CM 3 4 14. Special Handling Instructions andAdditicnal Information 4 . C.A@98862 CHER4TREC CON T RACT OfCCN24117 15. GENERATOR'SIOFFEROR'SCERTIFICATION: I hereby declare thalihe contents ofthis consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeledlplacerded, and are in all respects In proper canditlon for transport according to applicable international and national governmental regulations. if export shipment and I am the Primary Exporter, I certify Wal the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if l am a large quantity genead (b) (if I am a small quantity generator) Is true, Generatorsl0fferors Printed/T)fiped Name Signal Man Day Year 5. 144L ,4 11 15 1 [ C/1 J 16. International Shipments •-ponto U.S. ❑ Export from U.S. Pod of entryfexiC 1:11 m Transposer signature (for exports only): Date IeaNng U.S.: W 17. TransposerAcknowiedgmant of Recelptof Materials .y Transporter meVo y d Name Signa MoM Day y� Year 0 Ute` Transporter 2 Printed/lypea Name Signature -- Month Day Year h 18. Discrepancy t8a. Discrepancy Indication Space ❑ Quantity ❑Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection f Manifest Reference Number: 18b.Alternate Facility (or Generator) U.S. EPA ID Number J U rB+. Facilitys Phone: Ise, Signature ofAltemate Facility (or Generator) Month Day Year W19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 4, '.. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materialS covered by the man'eest except as Race In Item ice Pdnled7lyped Namee ^w Signature tvlonlfl l �Ye r EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. ( DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)