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JklL pe( s'Jq L . .Vq ns, q ) 7 Ll CtivY �I Please print ortype. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORMHAZARDOUS 1 . GenemlorlDNumbar 2. Page1of 3. Emergency Response Phone 4, Manifest Tracking Number WASTE MANIFEST I CAL D 0 0 4 05 5@ 5 1 $0. j _ 9300 011180907 JJ K 5. Generalors Name and Mailing Address Generators Site Address (if different than mailing address) ARAMARK 7070 S. LONGE Si. 5 T OCKTON CA k95206 Generators Phone: Q 22M.. r'i1 111i 6. anter 1 Company Name TransY17U.S. EPA ID Number 41G< AAS J ,�h/Od 2666 67 5 2 7. Transporter 2 Company Name U.S. EPA ID Number 8, Designated Facility Name and SlteAddress U.S. EPA ID Number CHEMICAL WASTE MANAGEIIVIENT, INC. 35251 QLD SKYLINE ROAD C A T 0 0 0 @ 4 Fi 1 1 7 BEET T LEM fl CIT`( :A @3239 Facility's Phone: 59 .W- Q7 1 go. 9b. LLS. DOT Desorption (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group if any)) No. Type Quantity WtN01. 1. ®f � NCRCR4HAf �3C}L15bdR$TESCLIGS 6 I C � EX108A02 z 2. w c7 - 3. 4. 14. Special Handling Instructions andAddifionai Information 1 . CA008852 CHEtt1TREG CONTRACT O CCN24117 15. GENERATOWSIOFFERORB 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 t0 applicable International and national governmental regulations. If export shipment and I am the Pdmary Exporter, I comfy that 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 I am a large quality generator) or (b) (if I am a small quantity generator) Is me. Generat0rsl0ffemrs Pdrdedffyped Name Signa a Month Day Year ..r 16. International Shipments F ❑ Import to U.S. ❑ Exportfrom U.S. Port ofeniry/exit: z Transporterslgnature (forexpods only): Date leaving U.S.: UJ 17. TransporterAcknowledgmentof Receipt ofMatedals Transporter 1 Pdnted/ryped Name Signature Month Oaf Year � Jin/i✓ 3 Transpoder2Pdn edfryped Name na a Month Day Year F- 18. Discrepancy '.. Ism Discrepancy Indication Space ❑ Quantify ❑Type - ❑ Residue ❑ Partial Rejection ❑ Full Refection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number U n FaclliVs Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Z y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) ® 1, 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of recelpt of hannims matedals covered by the manifest except as noted in Item Ise Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)