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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Paget of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAL 0 0 C1 4 0 " 8 9 1 f 8005 4 — 92 011180908 JJ 5. Gero ralars Name and Mailing Address Generators Site Address (if different than mailing address) ARANIARK 7674 S, LONGEST, STOCKTON CA95200 Generators Phone: `•r _ 6. Transporter 1 Company Name , U.S. EPA ID Number Pj4dAfryE � t / � A PAID Number Z mnsporter2 ompany Name - U.S. E 8. Designated Facility Name and SReAddress U.S. EPA ID Number '.. CHEN4ICAL WASTE MANAGEMENT, INC. 3"251 OLD SKYLINE ROAD C .A T 0 Q 0 6 4 0 1 1 7 KETTLEIv9:M CITY CA 93239 Facility's Phone: ( 659M& 97311 Be. 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. Type Quantity WtNoi. 0 NON RCRAHAZARLOLIS )AASTESOLID CA 08852 z 2. w pp 3. 1 4, 14. Special Handling Instructions andAdditlonal Information 1 . CA008852 CHEMTREC CONTRACT �efiCCN24117 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I herebydimare that the contents of this consignment are fully and accurately described above by the propershipping name, end are classified, packaged, marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable International and national governmental ragulalions. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform [Gibe terms of the attached EPAAcknowiedgment of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (IfI am a small quantity generator) is We. GpaymtorslQ�mr;Pdntedlfyped me Sig tun: Month Day Year ! a 13 129 1 / -A 16. International Shipments ❑ Importto U.S. Ll Export from U.S. Port ofenlry/ea - Transporter signature (for exports only): Date leaving U.S.: w 17. TmnspoderAcknowledgmentofReceipt ofMaterials Transporter 1 Prinfeirryped NameStgnafu - Month Day Year aTfanspoder2 Pindmirlyped Name ig re Month Day ear f- q. 18. Discrepancy 16a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: ieb,Alternate Facility (or Generator) U.S. EPAID Number J U <" Facllitys Phone: w 1Be. Signature of Alternate Facility (or Generator) - Month Day Year Q z 19. Hazardous Waste Report Management Method Codes (i.e., codas for hazardous waste treatment, disposal, and recycling systems) 65 i. 2. 3. 4. � 3 20. Designated Facility Owner or 0 eralor: Certification of receipt of hazardous materials covered by the manifest except as asked in item l a Printecirryped Name Signature Month Daycc Year �L con v...,., nvnn w tont a nGt o.,.,,;n„o nay no ern nr,oninm