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C;A.R��1I Please print or type. (Form designed for use on elite (12-pitch) typewriter.) - Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. GenemtorlD Number 2.Pagelof 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST C: ,� L 0 ® 0 Q 0 5 5 .1 ( 011180906 JJ K 5, Generators Name and Mailing Address Generator's Site Address (If digerent than mailing address) .4F6 MA K 7070 8, LONGE ST, STOC'(TON CA 95206 Generalars Phone: t? - " 6. Transp der 1 C mpany Name pn U.S. EPA IO Number j rte. . Transporter Company Name U.S. EPA ID Number 8. Designated Facility Name and SIMAddress U.S. EPA ID Number ` CHElv1ICfiVkAbE457l E [AAP9AC• EMEN'T, INC, 35261 OLD SKYLINE ROAD C A T 0 0 0 6 n 0 1 1 7 KETTLEMA{ 4 CITY CA 93230 Facility's Phone: ( a rx — rA71 K go. 9b. U.S. DDT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (irany)) No, Tyypee�t Quantity wt/Vol, 0 NON1. NRGRA HAZAPDOLISiA?ASTE SOLID ®/ fsA CABOx052 3. RRR 4. . _ —C 1 14. Special Handling lnsWctionsandAdd[Unnallnformagon ,g " 7 � ) 2 �)T � 1 CA0508352 CHEIVITREC CONTRACT -547t CN2Y I97 ] / 15. GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare that the contents ofthisconsignment or (oily and accurately describ ova byfhe proper hipping name, and are classified, packaged, marked and labeled/placarded, end are in all respects in proper condition fortramport according to applicable intemationaland national governmental regulations. if export shipmentand I am the Primary Exporter, I certify that the contents of this consignment oenform to the terms of the attached EPAAcknowiedgment of Consent. '.. I certify that the waste minimization statement identiked in 40 CFR 262,27(a) (if I am a large quantity generator) or (b) III am a small quantity generator) is land Gen torstOffemrs Printedfrype Name Signa - Month Day Year J 16. International Shipments F import to U.S. ❑ Exportfrom U.S. Pat of entry/exit'. a� Transporter signature (for exports only): Date leaving 0.S.! 93� 17. TransporterAcknowledgmenl f Receipt of Materials K Transpo Prinfed/fype .� 7 Signature /f�/ Month Day Ye r n0. /K u' i dLS QT nsporfer2P nted yped Name Signatu Month Day Year h 18. Discrepancy 18x. Discrepancy indication Space ❑ Quantity ❑Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181a. Alternate Fadlity (or Generator) U.S. EPA ID Number J . U c Facility's Phone: Ow 18c. Signature of Alternate Facility (or Generator) - Month Day Year 6 z 19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) 2 3. 4, 20. Designated Facility Owner or Operator: Codification of receipt ofhazardus materials covered by the manifest except as noted In 19jo illazi PdntedRyped Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) revlous of ifions are obsolete. DESIGN E ACILITR TO DESTINATION STATE (IE REQUIRED)